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Nursing Home-Hospice Relationships Garner Increased Government Scrutiny

For years, the government has warned nursing homes and hospices about requesting or providing illegal compensation to influence where nursing homes refer patients for hospice care. Such action is in direct violation of both the federal False Claims Act and the Anti-Kickback Statute.
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Now, in a series of prosecutions, the government is actively going after hospices and nursing homes that are violating these statutes by offering and accepting incentives deemed improper.

Some of the actions targeted have included:
–Requests by nursing homes that hospice providers offer services not technically considered hospice services. Some examples are around-the-clock, non-skilled companion services.
–Hospices found offering or giving free services or goods to staffers at nursing homes, including gift cards and baked goods.
–Hospices offering staff services at its own expense to the nursing home, when such services would normally be performed by the nursing home staff.
–Hospice providers giving services at the request of the nursing home facility, rather than in strict accordance to what the patient actually requires from a medical standpoint.

Although it’s possible some of these actions don’t cause direct harm to patients, the fact is that hospice referrals should be made on the medical needs of the patient – not on the kinds of benefits the nursing home and its staff can derive from that placement. When it does not, our Port St. Lucie nursing home abuse lawyers know there is a potential for mismanagement and possibly mistreatment. In fact, any time profits are placed over people, it breeds a troubling culture of corruption.

The government has known about this problem for years. In 1998, the Office of the Inspector General reported arrangements between hospices and nursing homes were found to be vulnerable to fraud because an exclusive or semi-exclusive arrangement with a nursing home for hospice services has great monetary value to the hospice provider. In some cases, that prompted requests or the offer of incentives to influence a decision to engage in such an arrangement.

Kickbacks in this arena, the government found, can result in over-utilization of the service, distort medical decision-making and may even negatively impact the level of care patients are getting. That’s aside from the fact that kickbacks are illegal.

Those caught violating these provisions face severe penalties. Those might include:
–A maximum $25,000 fine;
–A 5-year prison term;
–Fines of up to $11,000 per claim;
–Penalties of triple the damages sustained by the government;
–An order of non-payment for services rendered;
–Future exclusion from federal health care programs.

The government recently announced it will allocate approximately $2 billion to its health care fraud and abuse program next year, which is almost $700 million more than was spent in 2014. In the last several years, the rate of health care fraud prosecutions have risen sharply.

In 2013, the government recovered $4.3 billion received through fraudulent billing and other health care schemes. That marked the third straight year that more than $4 billion was collected for these type of abuses. Also that year, nearly 525 new health care fraud investigations were launched, which was a marked increase from the 300 initiated in 2009. Additionally, whistleblower cases doubled in that same time frame.

This is all good news because it means government regulators are paying attention to this issue. However, more must be done, as it’s likely there are still many cases that are going undetected.

Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights.

Additional Resources:
Nursing Facilities’ Compliance With Federal Regulations for Reporting Allegations of Abuse or Neglect, August 2014, Office of Inspector General

More Blog Entries:
Many Nursing Home Abuse and Neglect Cases Go Unreported, Sept. 15, 2014, Port St. Lucie Nursing Home Abuse Lawyer Blog

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