Hospice fraud allegations keep drawing the attention of federal investigators, as evidenced by a recent conviction and the government's intervention in a False Claims Act lawsuit.
A federal jury convicted Paula Kluding on 39 separate counts related to Medicare fraud, conspiracy, obstruction of a federal audit and making false statements in a healthcare matter, the Department of Justice announced. Kluding is the owner of Prairie View Hospice Inc. in Oklahoma.
For three years, she conspired with others to hide the nature of beneficiaries' health conditions, along with the quality and quantity of services they received.
Staff altered documentation to make it appear that nurses visited or assessed patients. Employees falsified nurses' notes to make it look as if beneficiaries' health conditions were worse than they were. Further, Prairie View sent falsified records to a Medicare subcontractor in response to a documentation production request.
Kluding faces up to 5 years in prison, a fine of up to $250,000 per count and an obligation to make restitution to the government.
In Las Vegas, meanwhile, the United States intervened in a False Claims Act lawsuit alleging that Creekside Hospice II LLC--along with its holding company and subsidiary--deliberately filed claims on behalf of beneficiaries who were medically ineligible for hospice benefits and overbilled for patient visits, according to the Department of Justice.
"The Medicare hospice benefit is intended to provide pain management and other palliative care to patients nearing the end of life, to help make them as comfortable as possible," said Acting Assistant Attorney General Joyce R. Branda in the announcement. "Too often, however, companies abuse this critical service."
The whistleblower alleges that Creekside altered medical records after filing claims to make it appear that Medicare requirements were met.
The complaint also alleges that staff actively discouraged patients and families from revoking their elections to accept hospice benefits, the Justice Department noted. Staff were reportedly told not to document patients' health improvements in medical records. Finally, the lawsuit alleges that Creekside inflated procedure codes on claims for medical director services.