#hospice of the comforter
Feds sue Hospice of the Comforter for Medicare fraud
January 14, 2013 | By Kate Santich, Orlando Sentinel
The federal government is suing Hospice of the Comforter for Medicare fraud, alleging that since at least 2005 the Altamonte Springs-based nonprofit knowingly billed for patients who were not terminally ill and even encouraged “creative” record-keeping to cover up the truth.
The facility could face millions of dollars in fines and damages as a result.
The suit, filed late last week by the U.S. Attorney’s Office, cites a case where the facility allegedly billed for hospice care over 4 1/2 years for an Alzheimer’s patient who was never considered terminally ill. Typically patients move to hospice care when they have less than six months to live.
In another case, when a nurse noted that a patient’s current condition would not qualify for hospice care, the diagnosis was suddenly changed to rectal cancer, the suit says, though there was no evidence the patient had cancer at any point during her 287-day stay in hospice.
At charges averaging more than $4,000 a month, bills for the two patients added up to more than $180,000 from Medicare the taxpayer-funded health-insurance program for the elderly and disabled.
The suit specifically alleges that longtime hospice CEO Robert Wilson instructed employees to admit patients without determining whether they were terminally ill, as Medicare requires, and then to bill the federal program for reimbursement. Staff also was instructed to find ways to document the cases in patients’ medical files so that the billings appeared legitimate.
Latour “LT” Lafferty, a Tampa attorney representing Hospice of the Comforter, said the charity “vehemently denies” that there was ever any intent to defraud the government. He also said management has been fully cooperative with the investigation and is trying to resolve the matter.
“What I can tell you is that Bob [Robert Wilson] has always been and is fully committed to providing the highest quality of care to his patients, regardless of whether or not they’re reimbursed by the federal government,” Lafferty said. “So if a person comes to Hospice of the Comforter seeking care, Bob will be the first person to give it to them, regardless of payment.”
Federal tax records show that Wilson made large bonuses based on how many patients were under hospice care each day.
Tax returns filed with the Internal Revenue Service for 2009, for instance, show that Wilson earned a base salary of $122,000, plus patient bonuses of nearly $207,000 for the year. That did not include retirement pay and other deferred compensation, including a clergy-housing allowance, that brought his total to more than $362,000. Wilson is a chaplain.
The latest allegations echo charges first made in October 2011 by a former hospice executive, who said he tried to get the hospice management to “do the right thing” by acknowledging improper Medicare billings and repaying the money.
When that effort failed, former vice president of finance Douglas Stone said, he was fired by Hospice of the Comforter. Stone filed his own federal whistleblower case but agreed in August to let the Department of Justice pursue the matter instead.
“I am pleased that after a more than yearlong investigation the Justice Department complaint describes in detail exactly what was alleged” in his own lawsuit, Stone said. “The Hospice of the Comforter Board of Directors had ample opportunity to do the right thing, follow the law, and return overpayments. Instead they allowed retaliation against a number of individuals making good faith efforts to report potential fraud.”
Wilson, who co-founded the hospice in 1990 and helped establish its well-regarded reputation in the community, referred a request for his comments to Lafferty. The attorney said Wilson is no longer CEO at Hospice of the Comforter, but he remains its president as well as chairman of the Comforter Health Care Group Board of Directors, the hospice’s parent company.
Although patients can and often do stay under hospice care for longer than the six-month guideline, a physician must periodically recertify the patient as terminally ill.
But at Hospice of the Comforter, the suit says, if a review committee recommended that a patient be discharged, the hospice would order more tests to delay the discharge and continue billing Medicare.
Wilson also had a list of patients whom nurses referred to in notes as FOBs, or “friends of Bob” who were not to be discharged regardless of what reviewers found, the suit says.
The total amount of actual damages, the government said, would have to be determined at trial, but the law allows the court to fine hospice as much as triple that amount.
Since May, Hospice of the Comforter has operated under a management agreement with Adventist Health System, the parent company of Florida Hospital chain, which reportedly had been interested in buying the facility at one point.
Spokeswoman Samantha O’Lenick would not comment on the lawsuit, noting that Adventist Health’s contract with the hospice went into effect after the whistleblower lawsuit was filed and so is not involved.