Florida Resorts Agree to Pay $325,000 to Settle False Claims Act Allegations Relating to False Certifications on a Paycheck Protection Program Loan Forgiveness Application
Jacksonville, Florida – Acting U.S. Attorney W. Stephen Muldrow announces that Haven Hospice (Haven), a hospice company headquartered in Gainesville, Florida, has agreed to pay $5,085,024 to resolve allegations that Haven violated the False Claims Act by knowingly billing the government for medically unnecessary and undocumented hospice services.
The government alleges that Haven knowingly submitted false claims to the Medicare and Medicaid programs for medically unnecessary hospice care for certain patients who had lengths of stays greater than three years. Typically, federal health care programs only pay for hospice care when patients are in a terminal condition and have a life expectancy of less than six months.
Since June 1, 2011, Haven treated at least 63 patients with lengths of stay exceeding three years. The government contends that for those 63 patients, Haven either knowingly or recklessly failed to document a valid basis for the initial start of hospice care and/or subsequent hospice coverage. Haven’s diagnoses were not adequately supported, or were supported only with inconsistent practitioner information. Many patients failed to demonstrate objective indications of decline throughout their time in the company’s care, despite some being in hospice for nearly six years. Some patients had their hospice diagnoses changed after several years when they did not show decline under their original “terminal” diagnosis. The government has agreed to accept $5,085,024 to resolve these allegations based on Haven’s ability to pay.
“Unfortunately, some healthcare providers seek to defraud Medicare by billing for unnecessary hospice services,” stated Acting U.S. Attorney Muldrow. “Left unchecked, this misconduct would deplete funds available for terminally ill patients desperately in need of the relief that hospice care provides. This settlement should serve as notice to others who consider similar practices that we will vigorously pursue them.”
“Charging taxpayers for unnecessary health care services such as hospice care is intolerable,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services, Office of Inspector General. “Working closely with our law enforcement partners, we will vigorously protect the integrity of our Federal health care programs and hold health care companies accountable.”
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by a former employee of Haven Hospice, Dr. John Simons. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act that permits private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action. Dr. Simons will receive roughly $900,000 of the proceeds from the settlement with Haven.
The government’s action in this matter illustrates the emphasis on combating health care fraud, and one of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, SafeGuard Services LLC (Medicare’s Zone Program Integrity Contractor), and the U.S. Department of Health and Human Services – Office of Inspector General. It was handled by Assistant United States Attorney Shea Gibbons.
The case is captioned United States ex rel. Simons v. North Central Florida Hospice, Inc. d/b/a Haven Hospice, Case No. 3:16-cv-330-J-32JRK. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.