Featured Health Business Daily Story, April 6, 2012, and featured in Government News of the Week, April 2, 2012

Feds Continue to Hammer Hospices Over The Lack of Patient Eligibility

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.

By BJ Taylor, Sales Associate
April 2, 2012Volume 21Issue 13

Two more cases against hospice providers were announced in late March as the federal government continues to crack down on alleged lack of patient eligibility and supporting documentation in hospice care (RMC 3/12/12, p. 4).

On March 23, the U.S. District Court for the Eastern District of Pennsylvania unsealed an indictment that charges five nurses in a health care fraud conspiracy related to their employment at Home Care Hospice, Inc. (HCH). According to the indictment, one of the nurses, Patricia McGill, who was also the director of professional services for HCH, allegedly authorized and supervised the admission of inappropriate and ineligible patients for hospice services, resulting in the submission of $9.32 million in fraudulent claims. McGill and four other nurses, Natalya Shvets, Giorgi Oqroshidze, Yevgeniya Goltman and Alexsandr Koptyakov, are charged with one count of conspiracy to commit health care fraud and numerous counts of health care fraud, according to the indictment.

HCH was co-owned by Matthew Kolodesh, who was charged separately in an indictment unsealed Oct. 12, 2011 (RMC 10/20/08, p. 8), and the hospice director for HCH, identified only as “A.P.”. Kolodesh was charged with conspiracy to defraud Medicare of more than $14 million. The new indictment alleges that McGill authorized nursing staff and supervisors to fabricate and falsify documents in support of hospice care for patients who were not eligible for hospice care, or to justify billing for a higher, more costly level of care than was provided to the patients. According to court documents, in anticipation of a 2007 audit, McGill allegedly assisted A.P. in reviewing patient charts, sanctioned false documentation by the nursing staff, and authorized the alteration of charts. In September 2007, HCH was notified that it had exceeded its cap for Medicare reimbursement and would have to repay $2,625,047, the court documents state. At that point, A.P. and McGill directed staff to review patient files and discharge hospice patients.

If convicted of all charges, McGill faces a potential sentence of 108 to 135 months in prison, a fine of up to $150,000 and a $1,400 special assessment. Shvets, Goltman and Koptykov each face a potential sentence of 27 to 33 months in prison, a fine of up to $60,000 and an $800 special assessment, with Oqroshidze possibly facing 21 to 27 months in prison, a fine of up to $50,000 and a $700 special assessment. Attorneys for the five defendants did not respond to RMC’s requests for comment.

In a second case, on March 27, Hospice of the Bluegrass, Inc., located in Lexington, Ky., agreed to pay $685,000 to settle false claims allegations, according to the U.S. Attorney’s Office for the Eastern District of Kentucky. According to the settlement agreement, from January 2002 to Dec. 31, 2008, Hospice of the Bluegrass submitted numerous claims to Medicare for services performed on patients who did not qualify for hospice care. The lawsuit originated with five employee-turned-whistleblowers.

In a statement, Eugenia Smither, vice president of compliance and quality at Hospice of the Bluegrass, said “the issue focused upon the physicians’ determination of the life expectancy and length of stay of terminally ill patients who received care nearly a decade ago.” She added that, although the physicians who specialize in hospice and palliative medicine disagree with the feds about the patients’ eligibility for hospice care, Hospice of the Bluegrass chose to settle after carefully considering the resources and time that would be necessary to litigate the issues.

View the HCH indictment at www.justice.gov/usao/pae/News/2012/Mar/mcgilletal_indictment.pdf.

© 2012 by Atlantic Information Services, Inc. All Rights Reserved.

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