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Types of Hospice Fraud

Doctor with stethoscope in handcuffs isolated on white

If you work in the hospice care industry, it is important to understand what may be considered hospice fraud. Because hospice deals with especially vulnerable patients, regulators and prosecutors are particularly wary of activity that could be construed as taking advantage of patients. Continue reading to learn about a few categories of hospice fraud prohibited in California, and if you have questions about a matter of healthcare law, reach out to a dedicated California healthcare law attorney.

Fraudulent Billing Practices

Hospice companies must take care to keep their bills detailed and accurate. They may not submit fake or overly inflated bills to private insurers or Medicare or Medicaid. Often, a whistleblower (an employee, a patient, a friend of a patient) will identify alleged fraud and report it to the authorities, giving rise to liability under the False Claims Act. Whistleblowers, defrauded patients, and the government may all have a cut of the damages sought against hospices accused of billing fraud.

Examples of billing fraud include:

  • Billing for a higher level of care than actually provided
  • Billing for the most expensive level of hospice care when not medically necessary
  • Billing for services that were not actually provided
  • Maintaining inadequate records that do not adequately justify admission or retention
  • Ordering redundant or unnecessary medication or other treatments

Improper Care

Hospice fraud can include actions taken to boost revenue without actually helping patients. This type of behavior is closely tied to billing fraud and may overlap. Some examples of fraudulent care practices include:

  • Falsifying records to fake physician certifications
  • Offering hospice benefits to patients who have not been certified by a physician to be terminally ill with a short enough life expectancy
  • Falsifying patient charts to justify continued care or admission of a patient
  • Improperly retaining patients whose health is improving instead of declining
  • Focusing on enrolling as many patients as possible without providing full, adequate care to each patient

Fraudulent Kickbacks

In addition to taking advantage of patients or falsifying bills, hospices act unlawfully when they take “kickbacks” from nursing homes and hospitals in exchange for patient referrals. Hospices are not permitted to give such kickbacks in order to gin up more business. Unlawful kickbacks may take different forms, including:

  • Hospice providers giving cash, free or discounted goods, and free or discounted hospice services to nursing homes in exchange for referring patients.
  • Hospices referring patients to nursing homes in exchange for the nursing home to refer the patient back to the same hospice when they require hospice care.
  • Hospices providing free or discounted skilled nursing services to a nursing home, even though the nursing home already receives Medicare payments for those services. The nursing home will then be expected to contract with the hospice company to provide services when the patient is eligible for hospice care.

Essential Advice and Representation for Your California Medical Practice

For assistance with matters of healthcare regulatory compliance, fraud defense, employment disputes, mergers and acquisitions, business disputes, licensing, or any other healthcare legal issue, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.

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