As the U.S. Department of Justice (DOJ) continues its aggressive scrutiny of care providers for evidence of fraud, Reuters reports that the DOJ has filed a False Claims Act complaint against Miami-based Vitas Hospice Services, the nation’s largest for-profit hospice provider with 52 hospice programs in 18 states and the District of Columbia. The complaint, which was filed in district court in Kansas City, Missouri last Thrusday, is the latest brought by the DOJ against hospice and skilled nursing facilities submitting fraudulent and inaccurate claims.
Allegedly, Vitas Innovative Hospice Care actively engaged in fraudulent claims submission practices that included inappropriate patient admissions and upcoded claims submissions to Medicare. The complaint charges the company with using deceptive marketing practices to mislead patients regarding their level of care needs as well as also actively encouraging its employees to bill for ‘crisis care’ that netted $742 more in daily reimbursement rates than ‘routine home care.’
After the release of a November 2012 study by the Office of the Inspector General showing that inappropriate payments to skilled nursing homes, most of which resulted from upcoding, cost the Medicare program $1.5 billion in 2009, the DOJ began fraud investigations in the sector. So far this year, the DOJ has settled with hospice centers in South Carolina and Arizona.