A civil whistleblower suit filed in Texas may shed more light on overcharges in the hospice sector, reports Kaiser Health News.
The federal lawsuit accuses the nation's largest hospice provider, Vitas HealthCare Corp., of defrauding the Medicare program through its work with two health maintenance organizations (HMO), WellMed Medical Management Group and Care Level Management.
The HMOs were able to offload patients whose fixed daily payments meant they took a loss for their hospice care, while Vitas--which received far more generous payments to provide care--essentially received an incentive to take these patients off the health plans' hands. Vitas cleaned up because most of those patients weren't terminal.
According to the whistelblower who filed the suit, former Vitas Manager Michael Rehfeldt, nearly a quarter of the patients under the company's care in the San Antonio area had been enrolled in hospice for more than 500 days, reports the San Antonio Express. Moreover, the suit accused Vitas of kicking the patients out of hospice care when they became so ill they required hospitalization.
According to Vitas officials, the company's average patient is in hospice care for 80 days, with half receiving care for 15 days or less, notes KHN.
The litigation was filed in 2009, but that seal was partially lifted by a judge last week.
"We are pleased because the feds and the state have declined to intervene," said WellMed spokesman Dan Calderon.