Last week, the Department of Justice announced its latest Medicare fraud settlement recovery. Odyssey Healthcare was accused of submitting false claims to Medicare for hospice services in two different qui tam cases and has agreed to pay $25 million to settle the accusations.
Medicare beneficiaries who have a terminal diagnosis of six months or less can receive hospice care that will be covered by the program. Within Medicare hospice care there are two types of services: routine and continuous home care. Continuous care can be administered to a Medicare beneficiary when the patient goes through a serious crisis or when their condition is such that the only form of treatment they can receive is intensive home care. Continuous care is the most expensive service hospices can provide. It also has the highest reimbursement rate available to a hospice. There are very specific requirements for a hospice to give this type of care to its Medicare beneficiaries.
According to the complaints, Odyssey submitted false claims to Medicare for continuous care that was either unnecessary or was performed without complying with Medicare’s requirements. Additionally, Odyssey was accused of enrolling and re-certifying non-terminal patients for hospice care. Finally, the lawsuits alleged that the company was violating a corporate integrity agreement that Odyssey had signed as part of a 2006 qui-tam lawsuit settlement.
The whistleblowers in the cases, Jane Tuchalski R.N. and Bryan Dingus were both former employees of the company. Tuchalski was a care provider in Wisconsin and Dingus was an executive director for the Norfolk, Virginia hospice. They will be receiving a $4,687,500.00 share of the settlement as a reward for disclosing Odyssey’s fraud to the Government. It was incredibly courageous for these individuals to take action against their employer. And it is particularly noxious for a company to take advantage of individuals who are terminally ill and in the last phases of their lives. Without whistleblowers like Tuchalski and Dingus, Odyssey’s alleged misdeeds could have gone undetected for even longer.
Blowing the whistle on your employer can be overwhelming and scary. If you are aware of fraud, contact the attorneys at Tycko & Zavareei to get information on the steps you can take and how you can protect yourself while helping the greater good.