The whistleblower law firm of Baum, Hedlund, Aristei & Goldman has announced a multi-million dollar settlement with San Diego Hospice & Palliative Care Corporation. The settlement resolves a 2012 qui tam lawsuit filed by whistleblower attorneys Mark H. Schlein and Diane Marger Moore on behalf of a former hospice nurse who claimed that San Diego Hospice knowingly submitted false claims for Medicare reimbursement.
San Diego Hospice billed for and received Medicare reimbursement based on care provided to patients that did not meet federal eligibility criteria for hospice care. In order to qualify for Medicare’s $172-per-day hospice care, a patient must have a diagnosis of six months or less to live. According to the San Diego Union Tribune, San Diego Hospice officials occasionally changed patient records to make it appear as though patients were dying when in fact they were getting better. The hospice also had an “open access” policy in 2005, opening their doors to “virtually all” patients, even if they were not eligible for hospice care according to federal rules.
The qui tam law suit led to a federal investigation and a comprehensive audit of patient records. The audit and investigation, coupled with admissions by its officers, resulted in the San Diego Hospice filing for bankruptcy and ceasing operations. Despite the bankruptcy, the U.S. has received an initial recovery of $1 million pursuant to the terms of the settlement agreement. When distribution of all bankruptcy funds is completed, it is expected that the government will recover millions more.