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JACKSON, Miss. (AP) — A chain of hospices in four states has agreed to settle a whistleblower lawsuit concerning overbilling for $5.9 million.
The settlement between the federal government and the St. Joseph Hospice chain, based in Baton Rouge, Louisiana, was announced Thursday in Jackson.
Federal prosecutors alleged that St. Joseph was driving up Medicare payments by billing for continuous care to patients who weren't eligible under federal rules.
Owner Pat Mitchell denied wrongdoing in signing the settlement. In an email forwarded to The Associated Press by a company attorney, Mitchell wrote that billing rules are unclear and that the company tried to provide the best care for patients.
"While we deny the allegations made by the government, we have agreed to settle this matter so that (St. Joseph) can avoid costly and protracted litigation," Mitchell wrote.
Hospices take care of people with terminal illnesses, usually focusing on easing their symptoms instead of trying to cure them, and usually caring for them at home. Mitchell owns 13 hospices in Louisiana, Mississippi, Texas and Alabama.
Deedy Diamond, Nichoel Chaisson and Sandra Fairley all worked briefly for St. Joseph in 2011 or 2012 and sued in December 2012 in Gulfport, Mississippi. As people who brought the fraud to the government's attention, they will split more than $1 million under the False Claims Act.
Continuous care is supposed to be used when a patient is having a crisis characterized by symptoms such as nausea, vomiting, diarrhea, shortness of breath or uncontrolled bleeding. Federal prosecutors say Medicare pays for it at nearly six times the daily rate for regular hospice care. However, the whistleblowers claim St. Joseph began marketing it as "around the clock hospice care," encouraging hospitals to discharge patients sooner and encouraging families to use the service.
Prosecutors described St. Joseph as an "outlier" that used and billed for continuous care much more often than other companies.
"The government found that there were a significant number of patients who received continuous care hospice services when there was no crisis, and thus, they were not eligible for such services. The result of this misuse of the continuous home hospice benefit was millions of dollars of false claims submitted to and paid by the government," prosecutors wrote in a news release.
Mitchell denied any intent to defraud, saying Medicare should help people die peacefully at home.
"Continuous home care enables hospice patients to do just that in periods of crisis," he wrote. "In addition, this service also benefits the Medicare program as patient hospitalization stays cost Medicare three to five times more than continuous home care."
The whistleblowers also alleged that St. Joseph routinely enrolled people who weren't eligible for hospice care under Medicare by falsely claiming they had less than six months to live. The government declined to pursue that claim.
Court papers show St. Joseph is supposed to complete its payments by January.
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