U. S. District Judge Debra Brown has sentenced a Mississippi hospice physician to five years in prison for taking $16 million in fraudulent Medicare claims.
Dr. Scott Nelson of Clevland, Mississippi was convicted last April of certifying patients for hospice who were not terminally ill. Some of these patients were able to testify in court against Nelson nearly 10 years after he referred them to hospice, according to the U.S. Attorney’s Office for the Northern District of Mississippi.
“Instead of earning an honest living by treating patients and billing fairly, this doctor chose to defraud the government and the taxpayers of money that was intended to help terminal patients needing end-of-life care,” Clay Joyner, U.S. attorney for northern Mississippi, said in a statement.
The court also ordered Nelson to pay $15 million in restitution. He had served as medical director for several hospice organizations.
The U.S. Department of Health and Human Services Office of Inspector General and the Mississippi Attorney General’s office investigated the case, as part of a several-year effort to reign in health care fraud in the state.
Also charged in the case were Charlene Brandon, Wendell Brandon and Annette Lofton, who who have pleaded guilty on the fraud allegations.
The trial comes at a time when a rash of new hospices in several states are coming under scrutiny for potentially unethical and illegal activities, most notably in California. The state has passed several laws to strengthen its hospice licensing process. Companies in Texas, Nevada and Arizona have also come under regulators’ radar.
“The state’s weak controls have created the opportunity for large-scale fraud and abuse,” the California Department of Justice indicated in a report. “We identified numerous indicators of such fraud and abuse by hospice agencies, which typically offer palliative end-of-life care to individuals with medical diagnoses of fewer than six months to live.”
Nationally, settlements and judgments under the False Claims Act exceeded $2.2 billion in the fiscal year ending Sept. 30, 2022, according to the U.S. Department of Justice. The department litigated 351 such cases last fiscal year, the second-highest number in a single year.
“Protecting taxpayer dollars by preventing fraud and abuse is a critical priority for the Department of Justice,” Principal Deputy Assistant Attorney General Boynton said in a statement. “The large number of settlements and judgments this past year demonstrates that the False Claims Act remains one of the most important tools for ensuring that public funds are spent properly and advance the public interest.”