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COST: Health Care for the Dying Who Aren't Dying - or Why This Hospice Got Sued

January 26, 2009 - 11:04am

We wrote a long post earlier this month on hospice payments, and how some hospices (usually for-profits) are enrolling patients that may need long-term care but don’t necessarily fit the criteria of the Medicare hospice benefit. Alabama's Birmingham News reports on a recent $24.7 million settlement SouthernCare is paying the federal government to settle claims that it fraudulently enrolled elderly people in hospice under the Medicare benefit. The problem: they weren’t dying.

The newspaper reported that the charges stem from two lawsuits unsealed earlier in January that were filed in Birmingham's federal court by two former employees of SouthernCare, a private company with 95 offices in 15 states. In agreeing to the settlement, the company admitted no wrongdoing. Two nurses were the whistle-blowers, and one estimated that half the SouthernCare patients were not appropriate for hospice. In fact, most of the patients, including elderly people approached in church, thought they were getting some extra home care, not end of life care.

Hat tip to Roy Poses, MD of the Health Care Renewal blog.