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Hospice Fraud Attorneys

Hospice care encompasses a broad range of supportive care services to beneficiaries expected to survive 6 months or less. A team of health care professionals and volunteers provide medical, psychological, and spiritual support, with the goal of helping dying patients, to have peace, comfort, and dignity, but without the expectation of cure during a terminal illness. Terminal illnesses may include cancer, advanced cardiovascular disease, and other disease processes. Hospice programs also provide respite services to support a patient’s caregiver family. Hospice care may take place at home, at a hospice privately-owned center, in an acute-care hospital or in a skilled nursing facility (SNF).

The Medicare hospice benefit provides for virtually all categories of care for the terminal beneficiary and is covered under Part A of traditional Medicare, even if the beneficiary was enrolled prior to receiving these services in a Medicare managed care plan. Regulations and guidance governing covered services under the Hospice benefit are outlined in 42 CFR 418.200 – 418.205. Medicaid programs have similar coverage conditions and benefits.

Hospices may be for-profit or not-for-profit. Some hospices, (non-profit as well as for-profit) have constructed inpatient facilities of their own, wherein all hospice services that may be required in an inpatient facility may be delivered to the beneficiary, in place of care delivery in a patient’s home, an acute care hospital, or long-term care facility not equipped to provide these services.

Hospice organizations with physical facilities of their own providing onsite services are referred to as General Inpatient Care (GIP). An HHS-OIG Report determined that hospices with ownership equity in dedicated facilities provided more GIP services to more Medicare beneficiaries for longer intervals of time than hospices without such ownership interests. The latter type of hospices (i.e., absent proprietary GIP interests) referred patients for fewer inpatient admissions with shorter lengths of stay to alternative sites of service [i.e., sub-acute nursing facilities (SNF) and acute care general hospitals].

Such differential utilization of inpatient beds between hospices with different ownership equity raises the possibility of Medicare fraud. It is unlikely that the morbidity (burden of illness) between the beneficiaries refereed to the two types of hospices – those with proprietary facilities versus those utilizing hospital or SNF beds – is sufficient to explain such differential use of inpatient beds. If discovered to be the case, such self-referral may constitute a violation under the Stark Law and raises the possibility of prosecution for fraud against the Medicare program.

REAL PEOPLE making real change Meet Some of our Heroes

Joe Strom

Johnson & Johnson
$184 Million

Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.

Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.

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Bruce A. Moilan Sr.

$27 Million

Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.

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Kathleen Hawkins

Dignity Health
$37 million

Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.

CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.

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"I collaborated with Nolan, Auerbach and White on a broad variety of cases where whistleblowers stepped forward to disclose tactics employed by large companies to influence physicians' medical decision-making in patient care. They provide ample resources to not only optimize their client cases, but in doing so consistently leverage best medical evidence to further patient safety and resource utilization.”

— Fred Polsky M.D., Former Medical Director, CMS Zone 7 Integrity Contractor

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