MahanyLaw is investigating a patient report that Seasons Hospice & Palliative Care is committing Medicare fraud. Under the federal False Claims Act, people with inside information about healthcare fraud involving tax dollars may be entitled to significant cash rewards for their information. The term “inside information” generally means a current or former employee of the wrongdoer. Although patients are usually correct in their observations of fraud, they typically do not have enough information to establish a “pattern and practice” of fraud.
According to the company’s website, “Seasons Hospice is a community-based organization with an ongoing mission to find creative solutions that add quality to end-of-life care. The caregivers at Seasons Hospice hold steadfast to the patient/family focus of hospice care.”
From reading reviews on the employee rating website, most Seasons Hospice staff give the company high marks for quality of care. Our beef, however, is that they are reportedly ripping off Medicare, Medicaid and private healthcare insurance.
When someone steals from Medicare or overcharges, everyone suffers. Because Medicare and Medicaid are funded with tax dollars, our taxes go up when healthcare providers overcharge. Same with private medical insurance. Increased charges mean higher health insurance rates. With so many families struggling to afford insurance, we have no tolerance of providers that try to cheat the system.
What We Know about Seasons Hospice
Our information suggests that Seasons Hospice provides services to patients who do not qualify for hospice care. Hospice is designated for people who require end of life care. Obviously it is impossible to accurately predict how long someone may live. The median stay for hospice patients is roughly three weeks, although the average length of stay is higher because roughly 12% of patients remain in hospice care for 6 months or longer.
We often find Medicare fraud in hospices that have a high percentage of long term patients. If our information is correct, Seasons Hospice has patients that remain for years.
We have also been told that Seasons Hospice will falsely report that a patient is receiving wound care to extend the length of their stay.
Finally we are told that patients will be billed for physician visits and other services that were never provided. Because patients in hospices are usually at the end of their life, prosecuting a case based on patient claims is difficult. Putting it bluntly, our witness is not likely to survive until trial. That is why we need a present or former employee to verify the information we have received.
According to the company’s website, Seasons Hospice operates facilities in Arizona, Oregon, Nevada, California, Florida, Illinois, Texas, Colorado, Wisconsin, Michigan, Indiana, Missouri, Georgia, Maryland, New Jersey, Pennsylvania, Delaware, Connecticut and Massachusetts.
Hospice Care and Medicare / Medicaid Fraud
The Justice Department and the Inspector General’s Office of Health and Human Services have been involved in many recent Medicare fraud prosecutions of hospices… Vitas Hospice Services LLC (2017 – $75 million), Haven Hospice (2017 – $5 million), Hospice Compassus (2018 – $3.9 million), Horizons Hospice (2018 – $1.240 million), and Home Care Hospice Inc (2018 – pending)
Like most private insurance, Medicare and Medicaid pay for hospice services. A patient is eligible if he or she is terminally ill. Generally that means a physician has certified that the patient has a medical prognosis of six months or less assuming the individual’s illness runs its normal course.
Hospice services are reimbursed on a per diem basis. That means the longer the patient stays, the more money received by the hospice provider. Since the patients are already at the end of their life, one way for a provider to game the system is to bring patients in earlier. In other words, before they qualify or meet eligibility requirements. We think that is what we are being told about Seasons Hospice.
Medicare offers four levels of per diem payment depending on the level of care provided. The lowest level of payment is for “routine care,” while the highest level of payment is reserved for “crisis care.” Another way of gaming the system is to bill for a higher levels of care than what is actually being provided.
We are looking for evidence that Seasons Hospice overbilled for crisis care, provided routine care while billing for a higher level of care or provided higher levels of care than were medically necessary. All of these are common Medicare fraud schemes. (As noted earlier, our information is limited, hence our investigation.)
We are also looking for evidence that Seasons Hospice is providing services to ineligible patients.
As an analogy, let’s look at the recent prosecution of Vitas. According to the government, Vitas overbilled Medicare for crisis care services with knowledge that such payment claims were false because the patients did not need crisis care. These patients should have received routine care paid at the lower per diem rate. In addition, the government alleged, some patients did not qualify for any level of hospice care because they did not have a life expectancy of six months or less. Moreover, the government alleged that publicly available data demonstrated that Vitas was billing Medicare for substantially more crisis care as compared to its peers.
In other hospice Medicare fraud cases we have observed, providers pressured sales staff to admit more patients and pressured clinical staff to maximize utilization. Altering medical records is a common method of getting patients falsely “qualified” for care.
Instead of doing what is best for the patients, some hospices are motivated by greed.
Seeking Seasons Hospice & Palliative Care Whistleblowers
As one of the most successful whistleblowing law firms in the nation, we are constantly on the lookout for fraud and corporate greed. Particularly in the healthcare field.
Many folks believe that Medicare fraud is a victimless crime. It isn’t. Taxpayers across the United States suffer. With an estimated 10% of healthcare spending being lost to waste and fraud, we are paying billions of dollars more each than is necessary. That pushes up taxes and medical costs.
There is also the issue of patient care. We observed in one skilled nursing facility case a provider that was forcing very elderly patients to undergo strenuous and painful physical therapy. Making an elderly person suffer needlessly at the end of their life is cruel. It is one thing to help an elderly person regain their independence. It is quite another to force a dying man to undergo daily PT simply so as to increase billings and profits.
Under the False Claims Act (29 states have similar laws for state funded Medicaid), insiders who are first to report and document these frauds are eligible to receive a cash reward of between 15% and 30% of what the government collects. Look at the recent Vitas case, that means an award of between $11,250,000 and $22,500,000!
Qualifying for an award means filing a sealed lawsuit in federal court. While the case is being investigated your name typically remains anonymous. Once the government concludes its investigation it can take over the prosecution, allow your lawyers to prosecute or ask the court to dismiss the case.
We handle all aspects of the prosecution and you never have to pay us any money unless we win. Our whistleblower clients have received over $100,000,000.00 in recent years.
To learn more, visit our hospice care fraud information page. Have questions or ready to help stop healthcare fraud? Contact us online, by email or by phone at (414) 704-6731 (direct). All inquiries are protected by the attorney – client privilege and remain confidential.
Bonus Awards for Illinois and California Seasons Healthcare Whistleblowers
California and Illinois have passed private insurance whistleblower laws. If you have information about Seasons Hospice defrauding private insurance companies, you may eligible for a separate reward from each of those states. Do you have information that will assist our investigation? Call us today.