#vitas hospice houston
Vitas accused of billing Medicare for bogus hospice charges
Posted: 6:43 p.m. Friday, May 3, 2013
The nation s largest hospice provider, South Florida-based Vitas, bilked Medicare by charging for people who were not terminally ill and sending crisis care bills for patients that nurses said were at church, bingo or the beauty parlor, federal officials allege.
One Florida patient was nonresponsive yet also somehow walking in company records, according to a 51-page complaint that the U.S. Department of Justice filed under the False Claims Act.
Company officials said Friday they will vigorously defend the lawsuit.
An investigation by The Palm Beach Post last year showed Vitas, a for-profit hospice provider based in Miami, billed the government for local patient stays that averaged 40 percent longer than those at non-profit competitors licensed in Palm Beach County. The newspaper s reporting also showed hospice was marketed at assisted-living facilities as a service for people who might actually get better. Federal law requires hospice patients to be diagnosed with six months or less to live and to give up curative treatment.
The federal complaint filed in U.S. District Court in Missouri on Thursday alleges a host of fraudulent billing practices in Florida and other states including California and Texas. Vitas operates 51 for-profit hospice programs in 18 states.
The suit names Vitas Hospice Services LLC and Vitas Healthcare Corp. of Florida among others including parent corporation Chemed Corp. of Cincinnati, which also owns Roto-Rooter plumbing. Vitas is the larger of the two Chemed businesses. Medicare accounts for more than 90 percent of Vitas revenues, which exceeded $1 billion in 2012, the suit says.
The government alleges Vitas focused on maximizing Medicare reimbursement for as many patients as possible while disregarding patients medical needs and Medicare guidelines.
The hospice regularly ignored concerns expressed by its own physicians and nurses regarding whether its hospice patients were receiving appropriate care, the complaint said.
The company s billing for highly expensive crisis care was nearly six times greater than the national average, accounting for 15 percent to 17 percent of its total revenue, according to the the suit.
Chemed s stock fell more than 16 percent Friday in trading on the New York Stock Exchange.
Chemed and Vitas intend to defend this lawsuit vigorously, a statement on Chemed s website said. Chemed and Vitas have made significant investments in controls, systems and procedures to uphold the highest industry standards and to maintain compliance with all regulatory requirements. Our compliance efforts are designed to ensure our services are provided only to eligible patients.
But the complaint alleges the business practices of Chemed and Vitas led to the submission of false or fraudulent claims.
Vitas and Chemed management regularly corresponded with Vitas field offices about each office s crisis care utilization, particularly when the crisis care rates were lower than defendants wanted, the complaint said.
In one memo, according to the government, a Vitas vice president of operations grilled a Texas employee about a decreasing number of patients in crisis care a more intense level of care that can cost the government $742 more per day than standard home care.
Would you give me your thoughts on what caused this drop and what will you be doing to correct in January? the memo said, according to the complaint. I will need this analysis by the end of the day today.
The federal governement began paying for hospice care in the early 1980s. The idea was some dying patients might choose to give up often costly and wrenching last-ditch treatments for terminal illness to spend their final days in as much comfort and dignity as possible.
Though many people think of hospice as a building, in most cases it is a service provided to patients in their own homes or in nursing homes or other facilities. Federal law requires a diagnosis of six months or less to live, though the complaint cited examples of patients on hospice for more than two years.
Examples cited in the complaint ranged from 2006 to 2012. Individual patients were not identified by their full names.
Patient TS in an unspecified Florida location was put on crisis care three different times over several months for conditions including weakness, anxiety and pain, but the government concluded she was never in crisis and required only an anti-anxiety drug at a low dose that should have been billed as routine home care.
The complaint said five days after Vitas began billing Medicare for crisis care for TS, the Vitas doctor noted that TS was nonresponsive, but also wrote that TS was walking.
Chemed set goals for the number of crisis care days it wanted Vitas to bill, according to the complaint.
Employees trying to meet such goals reported some odd things to the government, the suit said: One Vitas nurse stated that, on more than one occasion when Vitas sent her to the homes of patients whom she was told needed crisis care, she arrived ready to perform intensive nursing care only to find that the patients were at church, the beauty parlor, or playing bingo.
In an investigative report last year, The Palm Beach Post analyzed data showing local Vitas patients were staying on average 40 percent longer than those at non-profit competitors licensed in Palm Beach County. That meant higher bills for taxpayers. Such patients were less likely to have cancer and other fatal illnesses traditionally associated with hospice and more likely to have conditions such as dementia, The Post found. The newspaper also showed hospice services were being marketed at assisted-living facilities as a service for people who might not necessarily die — or even get better — though federal law requires a diagnosis of six months or less to live.
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