Utah-based Summit Hospice has agreed to settle allegations of False Claims Act violations for $1.05 million.
The U.S. Department of Justice indicated that claims resolved by the settlement are allegations only and liability was not determined.
The U.S. Attorney’s Office for the District of Utah investigated the allegations, along with the state’s Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). Utah is among the 32 states that have enacted FCA state legislation in addition to federal laws/rules.
OIG alleged in a recent report that Summit Hospice violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for non-covered hospice services.
“Hospice care is an important service that should provide patients with comfort,” Curt Muller, inspector at the special investigations branch of HHS-OIG, said in a statement from the Justice Department. “Providers who focus on personal financial gain rather than providing medically necessary, high-quality care to their patients undermine the integrity of these services. HHS-OIG will continue to work with our federal and state partners to ensure that hospice providers are giving their patients the care and comfort they need.”
The Justice Department alleged that between Sept. 7, 2021 and Oct. 1, 2018, Summit Hospice billed both Medicare and Medicaid for hospice services that were not medically necessary to patients
who were not terminally ill.
Trina A. Higgins, U.S. Attorney for the District of Utah, indicated in a statement that Summit Hospice submitted claims that “lacked documentation of a terminal illness to qualify for services.”
Summit Hospice denied the allegations.
FCA cases often hinge on the question of patient eligibility for hospice care based on a six-month terminal prognosis.
Across all health care settings, the federal government resolved roughly 350 FCA cases during 2022 and recovered nearly $2.2 billion that year, according to a report from law firm Foley Hoag LLP.
This marked the second-highest volume of settlements and judgements in a single year, though the dollar amount was down from $5.6 million in 2021, the law firm reported.