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  

James Fredrick Barger

University of Alabama - School of Law

Date Written: January 1, 2016

Abstract

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

Barger, James Fredrick, 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 (January 1, 2016). American Criminal Law Review, Vol. 53, No. 1, 2016. Available at SSRN: https://ssrn.com/abstract=2747543

James Fredrick Barger (Contact Author)

University of Alabama - School of Law ( email )

P.O. Box 870382
Tuscaloosa, AL 35487
United States

Paper statistics

Downloads
239
Rank
104,709
Abstract Views
834