Literature Review

 Health Care Fraud and Abuse 2023 Year in ReviewJD Supra; by Kevin Coffey, Meredith Eng, Haley Essner, Rebecca Hsu, Christopher Kim, Tessa Lancaster, Dayna LaPlante, Logan Moore, Angela Powers; 4/12/24 Polsinelli proudly introduces the Health Care Fraud and Abuse 2023 Year in Review, a comprehensive examination of the evolving landscape surrounding the False Claims Act (“FCA”) and fraud & abuse enforcement efforts in the United States. Since its significant amendments in 1986, the FCA has stood as a formidable tool in combating health care fraud, with the Department of Justice reclaiming over $75 billion in allegedly fraudulent proceeds. 

Glendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.Sierra Sun Times; 3/31/24The owner of two California-based hospice companies, along with his biller and consultant, were sentenced last Thursday for their respective roles in a scheme that resulted in stealing over $9 million from Medicare in false and fraudulent claims for hospice services. ... According to court documents, ...  [Gayk] Akhsharumov concealed his ownership and control over the hospice entities from Medicare, inserted nominee owners, paid kickbacks to patient recruiters, and profited from the scheme. In April 2020, after San Gabriel had ceased operations, Akhsharumov used the company to fraudulently obtain COVID-19 relief funds.

EnforceMintz - False Claims Act statistical year in review Mondaq - Mintz; by Kevin M. McGinty, Laurence Freedman, Karen Lovitch and Brian Dunphy; 3/27/24 Mintz's annual report on False Claims Act case activity analyzes data from the DOJ and the firm's Health Care Qui Tam Database, and explores the 2023 spike in FCA case activity, the ongoing moderate decline in health care–related activity, and continuing robust recoveries in health care cases. ... Also interesting is the absence of hospice care facilities from this year's table. In a number of recent years, those entities had been a growing category of FCA defendants in our internal data.

Care Alternatives, whistleblowers resolve hospice fraud suitBloomberg Law, by Daniel Seiden; 3/15/24

Medicaid Fraud Control Units Fiscal Year 2023 Annual ReportU.S. Department of Health and Human Services, Office of Inspector General; 3/14/2024Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. [This 32 page, downloadable document includes:]

A whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing? Delaware Online, by Esteban Parra and Xerxes Wilson; 3/4/24A former medical director specializing in neurosurgery at southern Delaware’s largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified “brain-dead” patients in order to overbill for services. ... [The whistleblower reported that] hospital officials discussed a "new hospital initiative" in which suspected "brain-dead" patients would be discharged and admitted to hospice before any declaration of brain death, according to the lawsuit. The scheme allowed for prolonged billing where previous billing ended with the patient’s death, the complaint states. [Please refer to the article for details.]

False Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).

How one hospice owner got convicted of healthcare fraud and how you can avoid that fateHospice Insights: The Law and Beyond, by Husch Blackwell; 2/21/24The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this [podcast] episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.

Doctor convicted of $2.8M hospice Medicare fraud schemeHomeCare; 2/20/24A federal jury convicted a California man for his role in a scheme to defraud Medicare by billing $2.8 million for hospice services that patients did not need. From October 2014 to March 2016, [John] Thropay fraudulently certified Medicare patients ... as having terminal illnesses that the patients did not have ... [in order to] bill Medicare for hospice services. In 2015, Thropay was listed as an attending provider for more hospice claims paid by Medicare than any other provider in the nation.

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.