Hospice care provider to pay $18 million for making false claims to Medicare hospice funds

Evercare allegedly filed hospice care claims for patients who were not eligible to receive that care

A Minnesota-based company that operates in Colorado will pay $18 million after falsely claiming Medicare reimbursement for patients who were not eligible for hospice care.

Evercare, now known as Optum Palliative and Hospice Care, settled a lawsuit brought by the Justice Department alleging that the provider knowingly submitted or caused false claims to be submitted to Medicare for hospice care from Jan. 1, 2007, through Dec. 31, 2013. These claims were proved false by Evercare’s medical records, which showed patients receiving Medicare hospice benefits even though they were not terminally ill.

The allegations arose from whistle-blower lawsuits filed by former Evercare employees. The government intervened under provisions in the False Claim Act and alleged that Evercare’s business practices were designed to maximize the number of patients it could bill Medicare for by discouraging doctors from discharging ineligible patients from hospice and failing to ensure accurate records were kept for patients’ conditions.

The agreement included no admission of wrongdoing by Evercare.

Since January 2009, the Justice Department has recovered more than $30 billion through False Claims Act cases, with more than $18.3 billion of that amount recovered in cases involving fraud against federal health care programs, according to a news release.

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Hospice care provider to pay $18 million for making false claims to Medicare hospice funds