Hospice Care Fraud

Caring for a patient in a hospice near the end of life can be complicated and expensive, and it may involve numerous types of services. When a hospice provider bills Medicare or another federal program for care, they must follow detailed requirements.

Combining the complex needs of a severely ill patient with the intricacies of federal billing rules creates a recipe for potential error. In certain cases, this error is viewed as an intentional attempt by a hospice provider to acquire extra funds. Other times, the provision of services may be questioned as unnecessary and therefore fraudulent.

Those being investigated for or accused of hospice care fraud deserve to have equally experienced legal counsel and representation from a qualified Michigan hospice care fraud lawyer to defend their rights. A dedicated healthcare fraud attorney can level the playing field and work to devise the right defensive strategy based on the unique facets of your case.

Instances of alleged hospice care fraud are often prosecuted under the criminal provisions of 18 United States Code §1347, which prohibits healthcare fraud in general. This section of federal law treats attempts at fraud in the same manner as instances where a hospice provider actually receives some benefit from a fraudulent scheme.

A provider violates the law if they knowingly and willfully execute or try to implement a scheme intended to either "defraud any health care benefit program" or fraudulently obtain money from a healthcare benefit program. These provisions apply to both the provision of healthcare services and the payment for services.

Those convicted of violating this law may face a maximum sentence of ten years in prison. Violators may also be fined hundreds of thousands of dollars, and the penalties may increase if hospice care fraud is determined to be responsible for causing a death. If you are under investigation of hospice care fraud, speaking with a Michigan attorney to learn which potential penalties you may face could be beneficial.

Special care should be paid to subsection (b) of this statute, which specifies that a person may be convicted even if they were unaware of the statutory prohibition and did not specifically intend to violate the prohibition. A Michigan hospice care fraud attorney can work with you to further clarify how the tenets of this statute may affect your case.

Fraudulent behavior can include many different types of circumstances. Some common instances of hospice care fraud that hospice care fraud lawyers in Michigan deal with include:

• Billing for services that were not necessary or not performed
• Accepting or paying kickbacks
• Upcoding or billing at a higher rate
• Unbundling to bill separately for services so the total amount received is higher
• Billing for services that were not provided
• Backdating admission dates
• Creating false documents to support a claim

In some cases, employees of a hospice care provider may commit these or other fraudulent activities without knowledge of the employer. While the employer may still be held liable, it might also be possible for defendants and their Michigan attorneys to argue for a reduction in penalties or other favorable outcomes.

Certain high-profile cases have caused hospice care fraud to be prominently featured on the proverbial radar for many federal enforcement agencies. Since potential civil and criminal penalties associated with these offenses are quite severe, hospice fraud allegations need to be taken seriously, even if formal charges have not yet been filed.

No matter the circumstances, a Michigan hospice care fraud lawyer may be able to help in numerous ways, from providing advice to collecting evidence to providing representation during formal and informal proceedings. To learn more about what options may be available in your particular situation, set up a consultation today.