Hospice to Shell Out $3 Million for Alleged Medicare Fraud

Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc. and AccentCare Inc—collectively known as Guardian, a for-profit company that provides hospice services in Atlanta, Georgia—agreed to pay $3 million following allegations that it submitted false claims to Medicare for hospice patients who were not terminally ill.

The Justice Department announced the settlement resolves allegations filed by whistleblowers Rose Betts and Jennifer Williams, former Guardian employees. 

“Hospice care is only medically appropriate—and reimbursed by Medicare—for terminally ill patients who are in the last months of their lives,” said Derrick Jackson, special agent in charge with the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG). “We will continue to vigorously investigate health care companies that put their own profits above their duty to give appropriate medical care to their patients and bill Medicare only for legitimate health care services.”

Hospice providers may only bill Medicare for hospice services for patients who elect for treatment during the last few months of their lives as a result of a terminal illness. Guardian allegedly falsified documents and billed Medicare between Dec. 1 2009 and March 31, 2012, for patients Guardian knew were not terminally ill, the authorities alleged.

“Medicare payments to hospices are increasing every year,” U.S. Attorney John Horn of the North District of Georgia said in a statement. “In order to preserve Medicare funds for services patients truly need, we will continue to pursue hospice providers who abuse the Medicare hospice benefit by billing Medicare for the care of patients who are not terminally ill.”

As a result of their efforts to reveal the fraud, Betts and Williams will each receive $510,000, according to the Justice Department.

“The Medicare hospice benefit is intended to provide comfort and care to patients nearing the end of life,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a prepared statement. “We will continue to aggressively pursue companies that abuse the Medicare hospice benefit to improperly inflate their profits.”

Guardian does not admit any wrongdoing in the settlement and the claims reflect allegations only.

Written by Amy Baxter