Frank A. Rubino , ESQ.

FEDERAL AND INTERNATIONAL CRIMINAL DEFENSE

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Medicare fraud and hospice care

Federal investigators might have a new target for Medicare fraud cases: hospice care providers. That industry has created headlines recently as high profile executives have been charged with fraudulent Medicare billing and with using taxpayer money for personal expenses. The entire hospice industry is facing fire for lax standards and insufficient controls on who gets billed and for what. With a large elder population, Florida is likely to be at the forefront of criminal investigations involving Medicare fraud and hospice care.

Hospice care has the laudable goal of allowing people to go through the final stages of life in peace and comfort. Many of the accusations involve patients whose conditions do not appear to qualify for hospice care. If a patient lives for several years in hospice care, or is later declared to be "no longer terminally ill," investigators may question whether any of the services provided were appropriate. In this way, hospice care providers may be punished for providing excellent treatment and helping their patients extend their lives. Paradoxically, these facilities may face criminal charges for keeping their patients alive.

According to Medicare officials, hospice care is restricted to patients who have had a hospice physician determine that they have 6 months or less to live. In a few extreme cases, Medicare has been billed for hospice care lasting for years. These situations draw the attention of investigators who have made finding and punishing Medicare fraud a top priority in the wake of the national health care debate.

Hospice care providers should be careful. The government is aggressively pursuing restitution and trebled damages from groups found to have overbilled. They are also pursuing criminal actions against executives, administrators and doctors who are suspected of involvement in improper billing. It is clearly a challenging time to be a health care executive.

Source: Orlando Sentinel, "Troubling hospice allegations don't stop here," Scott Maxwell, 1 November 2011

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Coral Gables Office

Frank A. Rubino, Esq.
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