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Types of Hospice Fraud Hospice Care Facilities Should Know

Types of Hospice Fraud Hospice Care Facilities Should Know

Some common examples of hospice fraud include: billing fraud, improper care/abuse, kickbacks, keeping patients on hospice care for long periods of time without medical justification, hospice enrollment fraud, and inflating the level of care beyond the care a patient actually needs.

Hospice Billing Fraud and the Federal False Claims Act

It is unlawful to engage in hospice billing fraud. Generally, hospice bill fraud involves false claims to Medicare or Medi-Cal. The False Claims Act is a federal law that imposes liability on persons and companies who knowingly make a false record or file a false claim regarding any federal health care program. This includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded directly, in whole or in part, by the U.S Government or any state healthcare system. 

Penalties Under the False Claims Act Under The Federal False Claims Act 31 U.S.C. §§ 3729

Violations under the federal False Claims Act can result in significant fines and penalties. Under the False Claims Act, 31 U.S.C. §§ 3729, anyone who violates the law “is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, . . . plus 3 times the amount of damages.”

Penalties Under the False Claims Act Under The California False Claims Act (FCA)

California also has a similar law known as the California False Claims Act (FCA). A person or organization who violates the California False Claims Act may be liable for three times the amount of damages sustained by the state or political subdivision. Furthermore, the On June 2020, the Department of Justice (“DOJ”) increased the penalties assessable under the False Claims Act (“FCA”). The DOJ raised the minimum penalty for a single false claim from $11,181 to $11,665; the maximum penalty from $22,363 to $23,331

Hospice Kickbacks and the Anti-Kickback Statue

Under the Anti-Kickback Statute, it is unlawful to “knowingly or willfully solicit, receive, offer or pay anything of value to induce referrals or items or services payable by a federal healthcare program, including Medicare.”

Common Examples of Hospice Kickbacks

Common hospice kickback include:

  • Hospice facilities referring patients to nursing home in order to encourage the facility to refer patients back to hospice for care;
  • Hospice providers/ facilities supplying nursing homes with below fair market value or free goods or hospice services in exchange for patient referrals;
  • Hospice making arrangements with external sources for referrals. such arrangement include the hospice offering an incentive to the external source in exchange for referring patients to the hospice; and
  • Offering payments in exchange for patient referrals

Penalties Under Anti-Kickback Statue

Penalties under the Anti-Kickback statue applies to any individual or entity, and violation of the Anti-Kickback Statute is a felony that is punishable by fines up to $25,000 per violation and prison up to five years, or both.

Experienced Hospice Fraud Defense Attorney

If you or a loved one is facing hospice fraud charges, other healthcare-related fraud charges, or is under investigation for such, we invite you to contact our Los Angeles Healthcare Fraud defense attorney today for a free confidential consultation at (213) 401-2777. Our office also provides criminal defense consultations via Zoom, FaceTime, and Skype during the COVID-19 pandemic.

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