Salt Lake City, Utah - A Salt Lake County, Utah health care company has agreed to pay $1,045,944.42 to resolve allegations they violated the False Claims Act by submitting claims to Medicare and Medicaid for non-covered hospice services.
The settlement resolves allegations that Summit Hospice knowingly submitted false claims for payment to Medicare and Medicaid between Oct. 1, 2018, and September 7, 2021, in violation of the False Claims Act. The United States alleged that during this period of time, Summit Hospice was billing for services that were not medically necessary, because the patients’ records lacked documentation of a terminal illness to qualify for services. Summit Hospice denies the allegations.
Hospice care is special, end-of-life care intended to comfort terminally ill patients. To be eligible for the Medicare paid hospice benefit, patients must be “terminally ill," meaning that the patients have a medical prognosis that their life expectancy is six months or less if the illness runs its normal course.
U.S. Attorney Trina A. Higgins for the District of Utah made the announcement.
The case was investigated jointly by the Office of Inspector General of the United States Department of Health and Human Services (HHS-OIG) and the Utah Attorney General’s Office, Medicaid Fraud Control Unit.
"Hospice care is an important service that should provide patients with comfort. Providers who focus on personal financial gain rather than providing medically necessary, high-quality care to their patients undermine the integrity of these services," said Curt L. Muller, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). "HHS-OIG will continue to work with our federal and state partners to ensure that hospice providers are giving their patients the care and comfort they need."
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Source: U.S. Department of Justice, Office of the United States Attorneys