Hospice fraud in South Carolina and the United States is an increasing difficulty as the number of hospice patients has exploded more than the late accretion few years. From 2004 to 2008, the number of patients receiving hospice care in the United States grew almost 40% to in the region of 1.5 million, and of the 2.5 million people who died in 2008, vis–vis one million were hospice patients. The overwhelming majority of people receiving hospice care do federal further from the federal government through the Medicare or Medicaid programs. The health care providers who have the funds for hospice facilities traditionally enroll in the Medicare and Medicaid programs in order to qualify to realize payments below these admin programs for facilities rendered to Medicare and Medicaid eligible patients.
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While most hospice health care organizations have enough maintenance take control of and ethical treatment for their hospice patients, because hospice eligibility below Medicare and Medicaid involves clinical judgments which may result in the payments of large sums of allocation from the federal doling out, there are tremendous opportunities for fraudulent practices and faithless billing claims by dishonorable hospice care providers. As recent federal hospice fraud enforcement activities have demonstrated, the number of health care companies and individuals who are delightful to attempt to defraud the Medicare and Medicaid hospice encourage programs is very very about the rise.
A recent example of hospice fraud involving a South Carolina hospice is Southern Care, Inc., a hospice company that in 2009 paid $24.7 million to allow an FCA feat. The defendant operated hospices in 14 subsidiary states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally in poor health, nonattendance of documentation of terminal illnesses, and that the company marketed to potential patients considering the treaty of to hand medications, supplies, and the provision of residence health aides. Southern Care moreover entered into a 5-year Corporate Integrity Agreement following the OIG as portion of the contract. The qui tam relators time-privileged on the subject of $5 million.
Understanding the Consequences of Hospice Fraud and Whistleblower Actions
U.S. and South Carolina consumers, including hospice patients and their intimates members, and health care employees who are employed in the hospice industry, as dexterously as their SC lawyers and attorneys, should obtain used to themselves considering the basics of the hospice care industry, hospice eligibility sedated the Medicare and Medicaid programs, and hospice fraud schemes that have developed across the country. Consumers mannerism to guard themselves from unscrupulous hospice providers, and hospice employees enhancement to guard bordering to knowingly or unwittingly participating in health care fraud adjoining the federal supervision because they may topic themselves to administrative sanctions, including elongated exclusions from operating in an meting out which receives federal funds, big civil monetary penalties and fines, and criminal sanctions, including incarceration. When a hospice employee discovers fraudulent conduct involving Medicare or Medicaid billings or claims, the employee should not participate in such actions, and it is imperative that the unlawful conduct be reported to whisk an encounter enforcement and/or regulatory authorities. Not unaided does reporting such fraudulent Medicare or Medicaid practices shield the hospice employee from ventilation to setting to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may lessening financially asleep the compensation provisions of the federal False Claims Act, 31 U.S.C. 3729-3732, by bringing disloyal claims suits, assumed declare qui tam or whistleblower suits, closely their employers nearly behalf of the United States.
Types of Hospice Care Services
Hospice care is a type of health care relief for patients who are terminally ill. Hospices moreover manage to pay for maintain facilities for the families of terminally ill patients. This care includes beast care and counseling. Hospice care is normally provided by a public agency or private company governor by Medicare and Medicaid. Hospice care is to hand for all age groups, including kids, adults, and the elderly who are in the terrific stages of excitement. The try of hospice is to offer care for the terminally ill cooperative and his or her associates and not to cure the terminal illness.
If a obliging qualifies for hospice care, the patient can lead medical and hold facilities, including nursing care, medical social services, doctor services, counseling, homemaker services, and added types of services. The hospice cooperative will have a team of doctors, nurses, domicile health aides, social workers, counselors and trained volunteers to benefit the tolerant and his or her familial members cope subsequent to the symptoms and result of the terminal disease. While many hospice patients and their families can make a be in pain of hospice care in the comfort of their residence, if the hospice patient’s condition deteriorates, the tolerant can be transferred to a hospice adroitness, hospital, or nursing blazing to recognize hospice care.
Hospice Care Statistics
The number of days that a patient receives hospice care is often referenced as the “length of stay” or “length of support.” The length of assist is dependent upon a number of different factors, including but not limited to, the type and stage of the illness, the mood of and access to health care providers by now the hospice referral, and the timing of the hospice referral. In 2008, the median length of stay for hospice patients was very approximately 21 days, the average length of stay was just just approximately 69 days, re 35% of hospice patients died or were discharged within 7 days of the hospice referral, and single-handedly approximately 12% of hospice patients survived longer than 180 days.
Most hospice care patients make known you will hospice care in private homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice inpatient facilities (21%), and acute care hospitals (10%). Hospice patients are generally the elderly, and hospice age action percentages are 34 years or less (1%), 35 – 64 years (16%), 65 – 74 years (16%), 75 – 84 years (29%), and on summit of 85 years (38%). As for the terminal disorder resulting in a hospice referral, cancer is the diagnosis for re 40% of hospice patients, followed by debility nameless (15%), heart illness (12%), dementia (11%), lung sickness (8%), exploit (4%) and kidney sickness (3%). Medicare pays the pleasant majority of hospice care expenses (84%), followed by private insurance (8%), Medicaid (5%), society care (1%) and self pay (1%).
As of 2008, there were in the region of 4,700 locations which were providing hospice care in the United States, which represented about a 50% mount going on again ten years. There were about 3,700 companies and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General Overview of the Medicare and Medicaid Programs
In 1965, Congress expected the Medicare Program to offer health insurance for the elderly and disabled. Payments from the Medicare Program arise from the Medicare Trust fund, which is funded by meting out contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (CMS), by now known as the Health Care Financing Administration (HCFA), is the federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership along with own going on governments to administer Medicaid.