A national for-profit hospice care company that is partially owned by a San Francisco private equity firm, has allegedly bilked Medicare of millions of dollars, according to a legal complaint filed this week by the U.S. Department of Justice.In court documents, the U.S. government alleges that since at least 2007, AseraCare Hospice of Texas has fraudulently certified patients as terminally ill to illegally collect Medicare payments. “AseraCare, through its reckless business practices, admitted and retained individuals who were not eligible to receive Medicare hospice benefits, because it was financially lucrative – and did so even after AseraCare’s auditor alerted AseraCare to troubling problems,” court documents state.
Federal attorneys also sued the hospice company, AseraCare, alleging it milked Medicare’s hospice benefit by pressuring its employees to enroll people into hospice who weren’t dying and resisted discharging them despite evidence they weren’t deteriorating. One hospice patient who should have been immobile from end-stage heart disease was healthy enough to go to his granddaughter’s graduation and a berry-picking excursion with a friend, the government charges.
The company is owned by Golden Living, a national company that provides skilled nursing services and other services as well as hospice. The whistleblowers contend that AseraCare first recruited patients eligible for skilled nursing care – also provided by Golden Living – for 20 days, for which Medicare pays the entire bill. After 20 days, when Medicare requires patients pick up a part of the tab, AseraCare had the nursing homes send the patients to hospice, according to the lawsuit. In hospice, AseraCare would collect a flat payment from Medicare for each day they are enrolled.
In written statements, AseraCare disputed the allegations and said it adhered to all Medicare rules for admitting hospice patients. “Consistent with hospice providers nationwide, AseraCare Hospice has evolved in recent years to treat more terminally ill patients with unpredictable disease progressions,” AseraCare’s president, Dr. David Friend, said in the statement. “It is simply not possible to precisely predict how patients will respond to challenging illnesses such as end-stage heart, lung and kidney disease, AIDS, and Alzheimer’s.”
