Literature Review

California Hospice Network: State falls short in curbing potential malfeasanceHospice News, by Jim Parker; 2/8/24The continued licensing of new hospices in California despite a moratorium is “deeply disturbing and frustrating,” the California Hospice Network (CHN) indicated in a statement. The practice is undermining efforts to combat hospice fraud, which has been rampant in California according to media and state government investigations. In 2021, the state enacted two hospice reform laws  — Senate Bill 664 and Assembly Bill 1280 — designed to strengthen oversight, including a moratorium on new licenses and an extensive audit of California’s licensing and oversight processes.

Hospice fraud back in the spotlight, with new data also raising questions about home health careHome Health Care News, by Robert Holly; 1/30/24The number of hospice providers enrolled in the Medicare program in four states has skyrocketed over the past few years. The jaw-dropping spike, in turn, has triggered increased oversight efforts – some of which may not be having the desired effect. A similar trend could be happening in home health care in one major county, U.S. Centers for Medicare & Medicaid Services (CMS) data suggests. In hospice, the surge of new providers and potentially fraudulent activities has been concentrated in Arizona, California, Nevada and Texas. In home health care, it’s Los Angeles County.

'Rock bottom': San Antonio doctor addicted to opioids wrote fake prescriptions for 40,000 dosesSan Antonio Express-News, by Guillermo Contreras; 1/23/24

Owner of defunct Skyline chain pleads guilty in $39M fraud caseMcKnight's Long-Term Care News, by Kimberly Marselas; 1/18/24Joseph Schwartz, former owner of Skyline Management and a 90-plus nursing home empire whose collapse sent patients and workers scrambling in 2018, pleaded guilty Wednesday to his role in a $39 million fraud scheme.

OIG report has clues for 2024 healthcare fraud enforcementLAW360, by Mackenzie Wortley, Elizabeth Nevins and Megan Miller; 1/16/24In late 2023, the U.S. Department of Health and Human Services and the U.S. Department of Justice released the Health Care Fraud and Abuse Control Program Annual Report for fiscal year 2022, highlighting continued enforcement and recovery actions under the program.

Nurse pleads guilty to federal charge for stealing pain medications at Baxter clinicBrainerd Dispatch; 1/9/24A registered nurse pleaded guilty to fraudulently obtaining prescription opioid pain medications from a hospice clinic, United States Attorney Andrew M. Luger announced Tuesday, Jan. 9. ... Cambie Elizabeth Broker, 33, was a registered nurse case manager at a hospice clinic in Baxter. Broker used her position to fraudulently obtain controlled substances from the clinic. Broker entered false prescription requests into the clinic’s e-prescribing software to fraudulently obtain oxycodone, hydromorphone, and fentanyl for illegal sale and personal use. 

Home healthcare company agrees to pay nearly $10 million to resolve false claims act allegations relating to its participation in the energy employees occupational illness compensation programOffice of Public Affairs; 1/5/24Atlantic Home Health Care LLC (AHH), a home health care agency operating in Arizona and eight other states, has agreed to pay $9,990,944 to resolve allegations that it violated the False Claims Act by submitting false claims to the Energy Employees Occupational Illness Compensation Program (EEOICP or the Energy Program), a healthcare program administered by the Department of Labor (DOL) for the benefit of Department of Energy employees and contractors with occupational illnesses.

Investigating Medicare hospice overpaymentsHospice News, by Jim Parker; 1/2/24As auditing activity by regulators continues to spike, hospices need to know how to conduct internal investigations to identify any potential improper payments.

Unlicensed Saratoga County nursing home operator to pay $650,000Times Union (Albany, NY)December 21, 2023Ballston Spa, NY—The unlicensed operator of a now shuttered Saratoga County nursing home is set to repay Medicaid $656,000 after an investigation by the state attorney general’s office and U.S. attorney for the Northern District of New York found years’ worth of fraud and resident neglect at the facility. 

Nursing homes still face data concerns, new audit saysTimes Union (Albany, NY)December 20, 2023Albany, NY—The state Department of Health largely failed to implement recommendations meant to improve infection control in nursing homes, according to an audit released by the state comptroller’s office on Wednesday. The audit came as a follow-up to a March 2022 audit by state Comptroller Thomas DiNapoli’s office that found data released by the Health Department “misled the public” and undercounted deaths in nursing homes. 

Steward Health Care hit with False Claims Act lawsuitHealthcare DiveDecember 20, 2023The federal government is suing Dallas-based Steward Health Care and its facilities, Steward Medical Group and Boston-based St. Elizabeth’s Medical Center, for violating the False Claims Act and a physician self-referral law, according to a Monday announcement. The complaint, filed in Massachusetts District Court, alleges Steward Medical Group improperly linked a lead cardiologist’s compensation with his referrals, leading the group to award him nearly $5 million in incentive-based pay—and violating physician self-referral rules, known as the Stark Law. 

Iowa nursing homes wait up to 41 months for an ‘annual’ inspectionIowa Capital DispatchDecember 15, 2023The state of Iowa isn’t meeting the federally mandated standards for nursing home oversight, with some care facilities waiting up to 41 months for an annual inspection. Federal regulations require that no more than 15.9 months elapse between annual inspections at individual Medicaid-certified nursing homes. The regulations also require that, collectively, the state inspect all nursing homes on an average of 12.9 months, if not sooner.

US Supreme Court refuses to hear fraud appeal for South Florida health care executive pardoned by TrumpSouth Florida Sun-SentinelDecember 11, 2023The U.S. Supreme Court on Monday refused to take up an appeal by a South Florida nursing-home operator whose 20-year prison sentence was commuted by former President Donald Trump after being convicted in what prosecutors called a “massive health care fraud scheme.” The Supreme Court rejected a petition by attorneys for Philip Esformes, who was found guilty in 2019 on 20 counts related to kickbacks, money laundering, obstruction of justice and conspiracy, according to court documents.