A former Hope Hospice manager brought the lawsuit against the organization.
FORT MYERS — Hope Hospice, one of the largest and most prominent end-of-life care facilities in the region, has agreed to pay $3.2 million to resolve a federal false Medicare claims case.
The allegations against Hope Hospice, according to a statement from the U.S. Attorney’s office, also include knowingly submitting false claims to Medicaid and TRICARE, a military insurance program. For all three programs, authorities contend Hope Hospice, a nonprofit with annual revenue of about $112 million, submitted false claims for care it provided to beneficiaries who were not terminally ill, and thus did not qualify for the service. The claims resolved by the settlement are allegations only, the release states, and there has been no determination of liability or determination of wrongdoing.
The settlement also concludes a lawsuit originally filed in U.S. District Court for the Middle District of Florida by Margaret Peters, formerly director of hospice care at Hope Hospice. Peters, the release states, sued under the qui tam, or whistleblower, provisions of the False Claims Act, which permits a private citizen to sue on behalf of the federal government for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. Peters will receive 19% of the proceeds from the settlement with Hope Hospice, according to the statement — $608,000.
As part of the settlement, Hope Hospice, which provides care to more 4,000 people a day in Southwest Florida, has agreed to enter into a Corporate Integrity Agreement with the U.S. Health and Human Services Office of Inspector General. The agreement, according to the statement, “promotes compliance with the statutes, regulations, program requirements and written directives of Medicare, Medicaid and all other federal health care programs, specifically dealing with, among other things, the proper billing and submission of reimbursement claims by Hope Hospice.”
Hope Hospice officials, in a separate statement, say the organization has "a long-standing, comprehensive compliance program that involves many qualified professionals and external auditors. In recent years, the organization has participated in many routine audits without issue." The settlement, Hope officials say, is a result of disagreements about documentation for care provided to 1% of Hope’s hospice patients between 2010 and 2016, and the funds returned represent 0.4% of total revenue received within the reviewed period.
"The decision to end this expensive legal distraction allows Hope to dedicate our resources to caring for the thousands of people who rely on Hope every day," Hope President and CEO Samira Beckwith says in that statement. "As we navigate this global pandemic, our resources are more precious than ever.”
Patients admitted to hospice care generally stop receiving coverage for traditional medical care intended to cure their illnesses and instead receive medical care focused on providing them with relief from the symptoms, pain and stress of a terminal illness. Medicare patients, according to the statement, are considered to be terminally ill and hospice eligible when they have a life expectancy of six months or less if their illness runs its normal course.
According to the settlement agreement, authorities contend that from July 1, 2012 to June 30, 2016, Hope Hospice billed Medicare for four or more years of hospice care for certain patients who were not terminally ill for at least a portion of their greater than four year hospice stay.
The settlement also resolves allegations Hope Hospice knowingly submitted false claims to Medicare, Medicaid and TRICARE for general inpatient (GIP) hospice care in circumstances where that higher level of care was not medically necessary. Those programs reimburse for four different levels of hospice care: routine home care, continuous home care, inpatient respite care and GIP. GIP is for pain control or symptom management that cannot be managed in other settings, such as a patient’s home, the release states. GIP is intended to be short-term and is reimbursed at a higher rate than routine home care or inpatient respite care. According to the settlement agreement, officials allege Hope Hospice knowingly submitted false claims from Jan. 1, 2011 to June 30, 2016, “to Medicare, Medicaid and TRICARE for unnecessary GIP hospice care for certain patients for whom Hope Hospice billed for over two weeks of GIP care.”
“Hospice care has brought peace of mind and reduced suffering for so many Floridians and their families,” Attorney General Ashley Moody says in the release. "It is vital that we ensure this compassionate health care service is not exploited and that Medicaid recipients nearing the end of their journey are able to access these end-of-life resources to help bring dignity and peace to those with terminal illnesses.”
The investigation was handled by the Fort Myers Division of the U.S. Attorney’s Office for the Middle District of Florida and Trial Attorney Holly Snow from the Civil Division’s Commercial Litigation Branch, with assistance from the U.S. Department of Health and Human Services – Office of Inspector General, Defense Criminal Investigative Service, and the State of Florida Medicaid Fraud Control Unit Civil Enforcement Bureau.
Founded in 1979, Hope Hospice is a subsidiary of Hope Healthcare. It provides services in Lee, Hendry and Glades counties.