A whistleblower reported Medicare fraud happening at an Indiana-based senior citizen residential healthcare company, and the Department of Justice settled with the company for $5.5 million. The whistleblower was a former employee of a hospice services company working with skilled nursing and long-term care services provider, American Senior Communities, L.L.C. (ASC). Under the qui tam provision of the False Claims Act, as a reward for reporting fraud, the whistleblower is entitled to 15-25% of the government’s recovery.

ASC offers a variety of skilled nursing and long-term care services to senior citizens in Indiana in the form of independent and assisted living communities, memory care, long-term care, and rehabilitation services.  According to the allegations, ASC was charging the government twice for Medicare beneficiaries who were on hospice.  Medicare beneficiaries have hospice benefits included in Medicare Part A, as long as they stay at a Medicare-certified hospice, their physician signs off that they are terminally ill, and the patient chooses the hospice benefit over Medicare paying for services related to curing their terminal illness.  Hospice services include nursing care, medical equipment and supplies, pain management medication, and various therapies and counseling intended to ease a patient’s condition but not cure their illness.

ASC allegedly billed Medicare separately for the services that are typically covered under Medicare’s hospice benefits.  While the government’s investigation uncovered an estimated $2,795,522.33 loss to Medicare, its investigation did not find that any patients were harmed.

Anyone who has witnessed a loved one or friend enter hospice understands the seriousness of the end-of-life care that happens in a terminally ill person’s final months.  Medicare covering some aspects of hospice care can be a relief for individuals and families who have faced the financial burden of caring for a terminally ill family member.  Fraudsters seeing a terminally ill person’s final days as a potential money-making opportunity to double-bill the government harms government healthcare program beneficiaries, their families, and taxpayers, as the costs for these services only go up to keep the programs solvent.

The Biden Administration has put nursing home operators on notice, charging the Department of Health and Human Services to ensure that nursing homes are adequately staffed by well-trained individuals, nursing homes’ funding is proportional to their performance, and “the public has better information about nursing home conditions so that they can find the best available options.”

Nursing home whistleblowers are key to ensuring the health and safety of senior citizen residents and, as said by the U.S. Attorney on this case, “critical to protecting public funds from fraud, waste, and abuse.”