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Justice News

Department of Justice
U.S. Attorney’s Office
Northern District of Iowa

Friday, December 18, 2015

Iowa Hospice to Pay More than $1 Million to Resolve False Claims Act Allegations

Iowa Hospice, LLC, has agreed to pay $1,088,244.02 to resolve civil allegations that it violated the federal False Claims Act by submitting false bills to Medicare for hospice services. 

The Medicare hospice benefit is only available to patients who elect palliative care (medical care focused on providing patients with relief from pain, symptoms, or stress) for a terminal illness and who have a life expectancy of six months or less if their illness runs the normal course.  The government alleged that Iowa Hospice knowingly submitted false claims to the government for payment of these services because, during some or all of the period that certain patients were receiving hospice care, the patients did not have a medical prognosis of six months or less if their illnesses ran their normal course.  The claims settled by the agreement are allegations only; there has been no admission or judicial determination of liability. 

“The Medicare hospice benefit is only intended for terminally ill Medicare beneficiaries who need end of life care,” said United States Attorney Kevin W. Techau.  “We will continue to diligently investigate and pursue all instances of misconduct in federal health care programs to ensure that no federal monies are misspent, all providers play by the rules, and patients receive the care to which they are entitled.”   

“Being a hospice provider in the Medicare program is a privilege, not a right.  Hospice providers that try to boost their profits by providing hospice care to Medicare beneficiaries who are not terminally ill compromise both the health of those patients as well as the financial integrity of Medicare,” said Special Agent in Charge Gerald T. Roy of the U.S. Department of Health and Human Services, Office of Inspector General.  “Our agency will continue to hold such hospice providers accountable for their actions.”        

The allegations resolved by the settlement arose from work performed by NCI Advancemed, and an investigation led by the Department of Health and Human Services, Office of Inspector General.  False Claims Act cases also arise under the qui tam, or whistleblower, provisions of the False Claims Act.  Under those provisions, a private party may file suit on behalf of the United States for false claims and share in any recovery. 

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Healthcare Fraud
Updated December 18, 2015