Life, Death, and Medicare Fraud: The Corruption of Hospice and What the Private Public Partnership Under the Federal False Claims Act is Doing About It
65 Pages Posted: 16 Mar 2016
Date Written: January 1, 2016
Once a humble, beloved, charity-based arm of the healthcare industry, hospice is now a multi-billion dollar industry, funded almost exclusively by Medicare, run by for-profit corporations answering to private equity investors and Wall Street, and more and more frequently plagued by fraud and abuse. This article gathers together for the first time in one place all of the publicly-available data related to law enforcement and regulatory enforcement of the Medicare Hospice Benefit. The author -- a well-known qui tam practitioner and False Claims Act scholar -- outlines the history and regulatory scheme of the Medicare Hospice Benefit and its payment provisions, the history and statutory scheme of the False Claims Act and its whistleblower provisions with particular emphasis on its use in the hospice fraud context, the relevant case law, and the joint efforts of whistleblowers and federal law enforcement attorneys and agents in ferreting out hospice fraud. The article includes in depth descriptions of representative cases as well as an exhaustive appendix which gathers information from cross-referenced sources and summarizes every publicly-available civil and criminal Medicare hospice fraud investigation.
Keywords: False Claims Act, Qui Tam, Hospice, Medicare, Fraud, Kolodesh, Home Care Hospice, Southerncare, Vitas, Aseracare, Odyssey Healthcare, Gentiva Healthcare, Kindred Healthcare, Hugh Westbrook, Cicely Saunders, Kubler-Ross
JEL Classification: H50, H51, H53, H55, I1, I10, I11, I12, I18, K14, K32, K42, K10, L33
Suggested Citation: Suggested Citation