A Las Vegas hospice illegally billed Medicare and Medicaid for patients who were not terminally ill, the U.S. Justice Department and the state of Nevada allege in a lawsuit filed Tuesday.
The lawsuit was filed in U.S. District Court in Las Vegas against Creekside Hospice II LLC, its holding company, Skilled Healthcare Group and Skilled Healthcare LLC, which provides administrative services to Creekside. The government claims the companies misspent tens of millions of dollars from Medicare and Medicaid.
Creekside Hospice disputes the allegations and said in a statement it will “vigorously defend” itself.
“[Creekside’s] caring health care professionals sufficiently documented the ongoing terminal status of hospice patients and provided excellent care,” according to the statement. “Hospice eligibility was appropriately determined by a patient’s attending physician and hospice health care professionals and hospice patients at Creekside receive outstanding and compassionate care.”
The statement also noted that the government’s complaint alleges 11 patients questioned services out of several hundred Creekside served at the time.
According to the government, the companies told staff to enroll patients in the hospice program regardless of their eligibility for the benefits, sometimes by telling staff to change records after the hospice submitted claims for payment. The government also alleges managers directed employees to change medical records to make it look as if doctors had visited patients when they hadn't. The complaint also alleges that hospice staff members were discouraged from documenting improvement to patients' health in order to keep Medicare and Medicaid payments coming.
The companies used billing codes that resulted in higher payments by Medicare than were justified, according to the lawsuit.
The allegations stem from a whistle-blower complaint brought by Joanne Cretney-Tsosie, a clinical manager for Creekside, and Veneta Lepera, a former clinical manager for Creekside, under the False Claims Act and the Nevada False Claims Act. In successful cases, whistle-blowers are entitled to a percentage of whatever the government is able to recover.
Follow Lisa Schencker on Twitter: @lschencker