What is Hospice Fraud?

The health care industry in Texas and across the country can give rise to many different types of fraud allegations, including a wide variety of federal criminal fraud-related charges. One type of fraud scheme that has been receiving increasing attention from state and federal investigators is hospice fraud. Hospice fraud schemes often result in health care fraud, Medicare and Medicaid fraud, kickback allegations, and conspiracy charges under federal law. What is hospice fraud and why are people facing a variety of federal charges related to hospice fraud? Our Dallas federal fraud defense attorneys have information to help clarify what types of allegations are involved in hospice fraud and what types of charges you can face as a result.

Learning More About Hospice Fraud

What is involved in hospice fraud? As the U.S. Department of Justice has begun investigating and prosecuting hospice fraud, it is important to understand the allegations involved in these cases. Generally speaking, hospice fraud involves a scheme by an assisted-living facility and/or a hospice provider to defraud Medicare by getting elderly patients into hospice care who do not actually meet the requirements for hospice care. In so doing, the parties involved in convincing older adults to choose hospice care are responsible for those older adults failing to get curative treatments and, as a result, suffering irreparable harm.

What are the typical facts in these types of cases? In most circumstances, an assisted-living facility will learn that a resident has a health care issue that is not terminal, but that is going to require significant medical treatment in a hospital setting or in a nursing home. The assisted-living facility then convinces the family of the resident, or a guardian of the resident, to select hospice care instead of moving the resident into a hospital or a nursing home. The assisted-living facility might explain that hospice care will not cost anything because it is covered by Medicare, and there are benefits to the resident because that resident will not have to spend time in a hospital or move into a nursing home—that resident can stay in his or her current home. In some cases, the assisted-living facility gets kickbacks from the hospice provider that agrees to provide the care.

However, as the American Cancer Society explains, hospice care is only designed for people with terminal illnesses, and it does not involve treatments that allow a patient to get better. Accordingly, patients who do not actually qualify for hospice care can suffer worsening conditions since they will not get the medical care they actually need.

Criminal Charges for Hospice Fraud

The U.S. Department of Justice recently issued a press release concerning arrests for hospice fraud. Two hospice facility owners were arrested for their involvement in a health care fraud scheme like what we described above, and receiving kickbacks. The press release explains that the parties “paid illegal kickbacks for the referral of Medicare beneficiary information that could be used to bill for purported hospice services,” and the parties “caused false and fraudulent claims to be billed to medicare for hospice services that were not medically necessary, not eligible for reimbursement, and not provided, including for services purportedly provided to Medicare beneficiaries who did not exist.”

Those parties are facing charges that are common in hospice fraud cases, including:

• Health care fraud;

• Conspiracy to commit health care fraud;

• Conspiracy to pay and receive kickbacks; and

• Paying kickbacks.

Contact a Federal Fraud Defense Lawyer in Dallas