Hospice agrees to pay nearly $1M to settle false claims liability
For Immediate Release
U.S. Attorney's Office, Southern District of Texas
CORPUS CHRISTI, Texas – A Corpus Christi health care company has agreed to pay $990,478.46 to resolve allegations they violated the False Claims Act by submitting claims to Medicare for non-covered hospice services, announced U.S. Attorney Jennifer B. Lowery.
The settlement resolves allegations that Familia Healthcare Services Inc. dba Del Cielo Hospice and Palliative Care knowingly submitted false claims from May 12, 2017, through Jan. 31, 2022. The claims allegedly involved hospice services for patients who were not eligible for, and did not qualify for, the hospice benefit in violation of the False Claims Act.
“This office is committed to pursuing providers who put profits ahead of patients,” said Lowery. “The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis, not a hospice provider’s desire to boost its profits.”
Hospice care is special, end-of-life care intended to comfort terminally ill patients. To be eligible for the Medicare hospice benefit, a patient must be “terminally ill,” meaning that the patient has a medical prognosis that their life expectancy is six months or less if the illness runs its normal course.
“The Medicare trust fund is not a piggy bank to be used at will by those intent on stealing from it,” said Acting Special Agent in Charge Jason Meadows, Department of Health and Human Services-Office of Inspector General (DHHS-OIG). We, along with our law enforcement partners, will use all available investigative tools and means of recovery to return stolen Medicare money to its rightful place. We implore citizens who are aware of Medicare fraud to come forward.
“Del Cielo Hospice didn’t just unscrupulously rob the Medicare program out of hundreds of thousands of dollars, it also took advantage of ill patients who were unknowingly used for its scam,” said Special Agent in Charge James Smith of the FBI. “This type of health care fraud affects everyone - individuals and businesses alike. It raises our health insurance premiums, exposes patients to unnecessary medical procedures, harms patients and increase taxes, not to mention the billions of dollars in losses every year. The FBI will continue to work with our partners, including the private sector, to identify and disrupt health care fraud.”
The settlement includes the resolution of claims a former employee of Del Cielo Hospice brought under the qui tam or whistleblower provisions of the False Claims Act. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The whistleblower will receive 16% of the proceeds from the settlement with Del Cielo Hospice.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services (DHHS) at 800-HHS-TIPS (800-447-8477).
The U.S. Attorney’s Office jointly conducted the investigation with DHHS – Office of Inspector General and FBI. Assistant U.S. Attorney Melissa Green handled the matter.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Updated August 19, 2022
Health Care Fraud