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Hospice care is a set of services meant to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient or the patient’s family members. Hospice care is also known as palliative care, which means care intended to alleviate suffering rather than cure an illness.
According to Medicare Regulations, to be eligible to elect hospice care under Medicare, the patient must be covered by Medicare Part A and be certified as terminally ill. An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course. Medicare only covers care provided by a Medicare-certified hospice.
A hospice company is permitted to admit a patient only on the recommendation of the hospice medical director in consultation with, or with input from, the patient’s attending physician if the patient has one.
In determining whether to certify that a patient is terminally ill, the hospice medical director is required to consider at least the following information:
The Certification of terminal illness must be based on the clinical judgment of the hospice medical director or physician member of the interdisciplinary group and the patient’s attending physician, if the patient has one, regarding the ordinary course of the patient’s illness.
The signed certification of terminal illness has to contain the following:
A beneficiary can be certified in this manner for two ninety-day hospice benefit periods or for six months. Before a beneficiary can be further certified for additional hospice cases, Medicare requires that a licensed physician or nurse practitioner meet face-to-face with the beneficiary to determine whether they are still eligible for hospice care. The physician or nurse practitioner must attest in writing that he has had a face-to-face meeting with the patient, including the visit date. The recertification needs to include an explanation of why the clinical findings of the face-to-face meeting support a life expectancy of six months or less.
Clients associated with hospice care companies are sometimes investigated or charged with Hospice Care fraud. Defendants may be accused of billing Medicare for hospice services for patients who were not terminally ill and did not qualify for hospice care. Sometimes, the Government will allege that patients and their families were not even informed that the patients were placed in hospice care. On some occasions, doctors are alleged to be paid illegal kickbacks. The Government may allege that these kickbacks were falsely labeled as “medical director fees” to refer, certify, or re-certify patients who do not qualify for hospice care. Medical personnel are sometimes accused of manufacturing medical records to support hospice care fraud for patients who did not qualify for such care.
Clients investigated for Federal Hospice Care Fraud may face a number of serious Federal charges. The charges that are likely to be filed in a Hospice Care Fraud case include:
Some hospice care companies may engage in fraud. Indeed, most hospice care companies do not engage in fraud. Hospice care is a legitimate business. Like any legitimate business, hospice care companies are subject to being used by some to commit criminal offenses.
However, a person going to work for a hospice care company would not have reason to be suspicious. As hospice care is a legitimate medical business, there is nothing about a hospice care company that would notify one that they would work for a crooked company. If some in a hospice care company are engaged in fraud, that does not mean every employee is involved. Sometimes, an honest, law-abiding person will go to work for a company that is engaged in fraud, and this honest employee has no knowledge of or involvement with the alleged fraud. A mere presence where a crime is being committed is not enough to make one guilty of being involved with that crime.
I have defended many clients who have been investigated or charged with a wide variety of different kinds of Federal Fraud offenses. Like other Federal Fraud Charges, Federal Hospice Care Fraud is a very serious federal offense that must be taken seriously. The key to victory, in any case, is preparation and hard work. If you are under investigation or charged with Federal Hospice Care Fraud and you would like me to represent you in federal court, call me at 713-655-7400.
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