A whistleblower reported Medicare fraud happening at an Indiana-based senior citizen residential healthcare company, and the Department of Justice settled with the company for $5.5 million. The whistleblower was a former employee of a hospice services company working with skilled nursing and long-term care services provider, American Senior Communities, L.L.C. (ASC). Under the qui tam provision of the False Claims Act, as a reward for reporting fraud, the whistleblower is entitled to 15-25% of the government’s recovery.
ASC offers a variety of skilled nursing and long-term care services to senior citizens in Indiana in the form of independent and assisted living communities, memory care, long-term care, and rehabilitation services. According to the allegations, ASC was charging the government twice for Medicare beneficiaries who were on hospice. Medicare beneficiaries have hospice benefits included in Medicare Part A, as long as they stay at a Medicare-certified hospice, their physician signs off that they are terminally ill, and the patient chooses the hospice benefit over Medicare paying for services related to curing their terminal illness. Hospice services include nursing care, medical equipment and supplies, pain management medication, and various therapies and counseling intended to ease a patient’s condition but not cure their illness.
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