US Joins Whistleblower Lawsuit Accusing Nevada For-Profit Hospice of Medicare Fraud
Both the United States Department of Justice and the state of Nevada have unsealed and joined a whistleblower lawsuit that alleges a for-profit hospice in Nevada committed Medicare fraud by overbilling the government agency.
The Skilled Healthcare Group operated the Creekside Hospice II, and according to whistleblowers Joanne Cretney-Tsosie and Veneta Lepera, who worked as clinical managers and filed separate federal lawsuits, the company submitted “tens of millions of dollars” in false Medicare claims between April 2010 and March 2013.
Creekside released a statement after the whistleblower Medicare fraud lawsuit was announced, stating that the company “disputes the allegations contained in the civil action that hospice services were provided to clinically ineligible Medicare beneficiaries and will vigorously defend the allegations. Its caring health care professionals sufficiently documented the ongoing terminal status of hospice patients and provided excellent care.”
The whistleblower claims involve what Creekside called “chart killers” – patients who improved while undergoing hospice care, so they may no longer qualify for the benefit. Hospice is care specifically for patients at the end of their lives. Reportedly, staff were discouraged from updating medical records to reflect these improvements. The company has also been charged with “upcoding,” meaning that medical records intentionally miscoded diagnoses to receive more funds, as well as falsifying medical records to indicate physician visits that never occurred, and taking inappropriate actions to prevent families and beneficiaries from revoking hospice care.
The Medicare fraud complaint identifies 11 patients that “questioned services” out of hundreds who received hospice care from Creekside between 2010 and 2013.
“As a result of the conduct alleged in the complaint, the government contends that the Creekside entities misspent tens of millions of taxpayer dollars from the Medicare and Medicaid programs,” according to the Justice Department statement.
Skilled Healthcare Group stated that the company “is disappointed that the government has brought this action under the False Claims Act when it has compelling information of appropriate hospice services and where it has not taken into account good faith clinical determinations by the hospice physicians and other care givers.”
Whistleblower Protections and Medicare Fraud Claims
“Qui Tam” are the first words of a Latin clause referring to the plaintiff as “one who sues as much for the state as for himself or herself.”
It is a provision of the Federal Civil False Claims Act that allows a private citizen to file a suit, in the name of the U.S. Government, charging fraud by government contractors and other entities that receive or use government funds. Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, whether financial institution fraud or Medicare fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.
Common whistleblower actions include:
- Medicare fraud,
- defense contractor fraud, and
- other kinds of fraud against state or federal government
Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud.
The Strom Law Firm Can Help Protect Medicare Fraud Whistleblowers with the False Claims Act
If you are personally aware of a fraud that has been committed by your current or former employer, a competitor or otherwise, from tax evasion to Medicare fraud, contact the Qui Tam attorneys at the Strom Law Firm today for a no cost consultation to discuss the facts of your case and whether filing a qui tam may be appropriate. We understand the complexity of the False Claims Act, and can help you with your case. We offer free, confidential consultations so contact us for help today. 803.252.4800