Hospice Company and Owner Agree to Pay $1.24 Million to Settle Two False Claims Act Whistleblower Lawsuits
PITTSBURGH – A privately owned for-profit hospice company and its owner and Chief Executive Officer agreed to pay the United States $1,240,000 to resolve allegations that the company had fraudulently billed Medicare and Medicaid for hospice services for patients who were ineligible for hospice, United States Attorney Scott W. Brady announced today.
The settlement resolves allegations in two whistleblower lawsuits filed in federal court in Pittsburgh, Pennsylvania against Horizons Hospice, LLC and its owner and Chief Executive Officer John C. Rezk ("Defendants"). The settled claims contend that from June 27, 2007 to August 1, 2012, Defendants submitted or caused to be submitted false claims to Medicare and Medicaid for patients who did not qualify for hospice because they did not have a life expectancy prognosis of six months or less. Typically, federal health care programs only pay for hospice care when patients have terminal illnesses with a life expectancy of less than six months. The settled claims also contend that Defendants falsified records to support the false claims. Horizons Hospice, LLC later changed its name to 365 Hospice, LLC. The alleged fraud occurred while the company operated as Horizons Hospice.
"Medicaid and Medicare are programs intended to provide care and assistance to the most vulnerable members of our communities, including seniors," said U.S. Attorney Brady. "Those who seek to defraud these programs will be vigorously pursued by my office. This settlement is another step forward in that fight."
This matter was investigated by the Office of Inspector General of the United States Department of Health and Human Services with assistance from the Federal Bureau of Investigation. Assistant United States Attorneys Paul E. Skirtich and Rachael L. Mamula handled the investigation that led to this settlement on behalf of the United States.
The cases are captioned United States ex rel. Thomas v. Horizons Hospice LLC (No. 12-cv-315) and United States ex rel. Mizak, et al. v. Horizons Hospice LLC, et al., (No. 13-cv-1688).
The claims resolved by the settlement are allegations only, and there has been no determination of liability.