Illinois hospice charged in $125M fraud case

The owner of an Illinois hospice services provider is facing charges of defrauding Medicare and Medicaid of millions in false hospice payments. Federal prosecutors allege that Seth Gillman, the administrator and one-quarter owner of Passages Hospice, Lisle, Ill., knowingly encouraged employees to document claims for hospice care that exceeded what was medically necessary and/or was beyond the care that actually took place.

According to the Federal Bureau of Investigation release on the case, Passages received more than $125 million in payments from Medicare or Medicaid from 2008 to 2011. Among the 4,700+ hospice patients whose bills are included in the fraud case, many were admitted to hospice care without terminal diagnoses and/or were receiving hospice care for years—far exceeding the “six month or less” life expectancy required for hospice placement.

In addition to fraudulent billing, Gillman is also accused of training his employees “to look for signs that allegedly would qualify a hospice patient for general inpatient care (GIP), resulting in higher payments per day, compared to routine care,” and then giving large bonuses to the Passages’ directors who had the most GIP cases under their supervision, the FBI document notes.

Passages has no physical inpatient facility of its own but maintains business relationships with multiple nursing homes across the state. Gillman also is accused of paying eight nursing homes $250 a day for each hospice patient using a GIP claim.

Topics: Executive Leadership , Medicare/Medicaid