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Hospice care fraud is becoming an increasingly significant issue in the healthcare industry, with millions in Medicare funds allegedly fraudulently paid annually. In 2023, an estimated $198.1 million in alleged fraudulent activities was reported. For those accused of Hospice Care Fraud, the experience can feel overwhelming. When Medicare and Medicaid are involved, the stakes are high, and even a small misstep can lead to serious legal consequences.

Understanding Hospice Care Fraud

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:

1. Diagnosis of the terminal condition of the patient;
2. Other health conditions, whether related or unrelated to the terminal condition and
3. Current clinically relevant information supporting all diagnoses.

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:

1. A prognosis for a life expectancy of six months or less if the terminal illness ran its ordinary course;
2. Clinical information and other documentation that supports the prognosis; and
3. A brief narrative explanation of the clinical findings that support a life expectancy of six months or less.

Investigation of Hospice Care Companies and their Employees

Employees, including doctors,  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.

Sometimes, the Government will allege that the accused certified  patients for hospice care, when the patient did not qualify. The Government  may allege  that the hospice company billed Medicare for unjustified 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.

Potential Federal Criminal Charges in Hospice Care Fraud Cases

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:

• Conspiracy to Commit Health Care Fraud;
• Substantive Health Care Fraud;
• Conspiracy to Commit Money Laundering;
• Conspiracy to Pay and Receive Kickbacks

Potential Penalties for Hospice Care Fraud

Individuals charged with hospice care fraud may face serious federal sentences. The amount of the alleged fraud as well as the abuse of positions of trust, and potential danger to the patients are just some of the factors that influence the potential sentence.  If convicted, these charges can result in imprisonment, ranging from several years to decades, depending on the severity of the offense.

Fines

The fines for hospice care fraud can be substantial. Individuals may be required to pay restitution, which is the repayment of funds received through fraudulent activities. Additionally, fines imposed by the court can range from thousands to millions of dollars.

Loss of Medical License

Healthcare providers found guilty of hospice care fraud may face professional consequences, including the revocation or suspension of their medical licenses.

Exclusion from Medicare and Medicaid Programs

Individuals convicted of hospice care fraud may be excluded from participating in Medicare and Medicaid programs. This exclusion can have severe financial implications, as Medicare and Medicaid are major sources of revenue for healthcare providers.

Houston Hospice Care Fraud Lawyer: Strong Defense for Serious Charges

If you or a loved one has been affected by hospice care fraud in Houston, you need legal representation that understands the complexity of these cases and knows how to fight for your rights. With 40+ years of experience, Robert Fickman is committed to protecting your rights. His understanding of complex healthcare regulations allows him to challenge the prosecution’s claims and question government investigations. Known for his aggressive defense strategies, Robert works directly with you to craft a customized approach, ensuring every possible avenue is explored to reduce charges or achieve dismissal. His reputation for fighting relentlessly makes him a powerful ally when your future is at stake.

Don’t let hospice care fraud charges jeopardize your future. Contact him for a consultation at 713-655-7400 or through our online contact form, and take the first step toward a strong defense.