WASHINGTON – SouthernCare Inc. and its shareholders have agreed to pay the United States a total of $24.7 million to settle allegations that the Birmingham, Ala.-based company submitted false claims to the government for patients treated at its hospice facilities, the Justice Department announced today. SouthernCare operates approximately 99 locations that provide hospice services in 15 states.
Hospices provide palliative care – any form of medical care or treatment that concentrates on reducing the severity of a disease’s symptoms – to patients who decide to forego curative care of their illness. Medicare beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less to live. The government alleged that SouthernCare was submitting false claims for hospice care for patients who were not eligible for such care.
"The Medicare hospice benefit is intended to provide compassionate end of life care to terminally ill patients," said Gregory G. Katsas, Assistant Attorney General of the Civil Division. "This settlement sends a clear message that the Department of Justice will not allow health care providers to take advantage of beneficiaries in their attempts to game the reimbursement system."
Today’s settlement results from two qui tam suits filed by two former SouthernCare employees, Tanya Rice and Nancy Romeo, on behalf of the United States. The False Claims Act authorizes private parties to file suit against those who defraud the United States and to receive a share of any recovery. The United States will pay $4.9 million to the individuals who filed the actions against SouthernCare.
"Our investigation showed a pattern and practice to falsely admit patients to hospice care who did not qualify and to bill Medicare for that care. This resulted in taxpayers bearing inappropriate costs. Today’s settlement evidences the Department of Justice’s efforts to both protect the public monies and safeguard Medicare beneficiaries," said Alice H. Martin, U.S. Attorney for the Northern District of Alabama.
"This significant settlement demonstrates our commitment to protect the Medicare trust fund from fraud and abuse and to ensure that Medicare beneficiaries receive quality care," said David E. Nahmias, United States Attorney for the Northern District of Georgia,. "Every provider that submits claims to the Medicare program must ensure that its services are billed appropriately. Falsely admitting people to hospice care who did not qualify for the benefit exposed these patients to potential harm and contributes to the soaring costs of health care for everyone."
As part of the settlement, SouthernCare will enter into a Corporate Integrity Agreement with the Office of Inspector General (OIG), Department of Health and Human Services (HHS), to address the allegations raised in the qui tam complaints.
"Today’s Corporate Integrity Agreement contains rigorous provisions specifically designed to ensure SouthernCare’s future compliance with Medicare and Medicaid hospice eligibility requirements," said Daniel R. Levinson, Inspector General for HHS. "This agreement demonstrates OIG’s commitment to protect the integrity of federal health care programs."
The investigation was jointly handled by the U.S. Attorney’s Office for the Northern District of Alabama, the U.S. Attorney’s Office for the Northen District of Georgia, the Justice Department’s Civil Division, Office of the Inspector General of the Department of Health and Human Services and the FBI.