Practice Areas

Hospice Fraud

Hospice fraud occurs when providers enroll patients who are not terminally ill, keep patients enrolled beyond what the medical record supports, or submit inflated claims to Medicare for services never provided. If you work in a hospice organization and have witnessed any of these practices, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.

Practice Areas

Hospice Fraud

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WHAT IS HOSPICE FRAUD?

Medicare’s hospice benefit covers palliative care and pain management for patients who are terminally ill, defined by Medicare as having a life expectancy of six months or less if the illness runs its normal course. To receive hospice coverage, a physician must certify that the patient meets this eligibility criteria. The hospice provider assumes responsibility for the patient’s end-of-life care and Medicare reimburses the hospice on a per-diem basis for as long as the patient remains enrolled.

Hospice fraud occurs when providers exploit this benefit by enrolling patients who do not meet the terminal illness criteria, continuing to bill Medicare for patients who no longer qualify or have recovered, or submitting claims for services that were never provided. Because these claims are submitted to Medicare, they fall within the scope of the False Claims Act. Healthcare insiders who have direct, first-hand knowledge of hospice fraud may be eligible to file a qui tam lawsuit on behalf of the government and receive a share of any financial recovery.

Saad Healthcare agreed to pay $3 million to settle False Claims Act allegations that it billed Medicare for hospice patients in Alabama who were ineligible for the benefit. The case was brought by two former Saad employees under the qui tam provisions of the False Claims Act.

Source: Source: U.S. Department of Justice, February 21, 2025 | justice.gov

Legal basis: 31 U.S.C. § 3729 (False Claims Act) | 42 U.S.C. § 1395d (Medicare hospice benefit) | Source: uscode.house.gov

TYPES OF HOSPICE FRAUD THIS PRACTICE HANDLES

Hospice fraud takes several forms. The following are the most common types handled by this practice.

Non-Terminal Patient Enrollment: Enrolling patients in the Medicare hospice benefit who do not have a terminal diagnosis with a life expectancy of six months or less. This may involve physicians who certify terminal illness without an adequate examination, documentation that overstates the severity of a patient’s condition, or pressure placed on clinical staff to certify patients who do not qualify. Every claim submitted to Medicare on behalf of an ineligible patient constitutes a false claim under the False Claims Act.

Improper Recertification: Medicare requires hospice providers to recertify that a patient remains terminally ill at regular intervals. Improper recertification involves certifying continued eligibility for patients who have stabilized, improved, or whose prognosis no longer supports a six-month life expectancy. Nurses, clinical staff, and case managers who are aware of patients who are not recertified appropriately may have direct knowledge of a fraud scheme.

Inflated Hospice Claims: Billing Medicare for hospice services at a level of care that was not provided, including billing at the continuous home care rate or general inpatient rate when only routine home care was delivered, billing for services that were not rendered, or submitting claims for deceased patients. Staff involved in billing, scheduling, or clinical documentation may be aware of discrepancies between what was provided and what was billed.

Kickbacks for Hospice Referrals: Some hospice fraud schemes involve payments to physicians, marketers, or other referral sources in exchange for directing patients to a hospice organization, regardless of whether those patients qualify for the benefit. These arrangements violate the Anti-Kickback Statute and render any resulting claims to Medicare false under the False Claims Act.

Legal basis: 42 U.S.C. § 1395d (Medicare hospice benefit) | 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 31 U.S.C. § 3729(a)(1)(A) and § 3729(a)(1)(B) | Source: uscode.house.gov

WHO CAN REPORT HOSPICE FRAUD?

The strongest hospice fraud qui tam cases come from current or former employees who have direct, first-hand knowledge of the fraudulent conduct from inside the organization. This includes nurses, hospice aides, and clinical staff who know whether patients are genuinely terminal and receiving appropriate palliative care, physicians who have been pressured to certify or recertify patients who do not meet the eligibility criteria, billing and coding staff who are aware of claims being submitted for services not provided or at levels of care not delivered, case managers and intake coordinators who observe enrollment of clearly ineligible patients, and compliance officers who have raised concerns internally that were ignored or suppressed.

You do not need documents or conclusive proof before reaching out. If you have witnessed conduct that you believe constitutes false billing to Medicare in connection with hospice services, that is enough to start a confidential conversation. We investigate thoroughly before asking for any commitment.

In fact, many former employees come forward with knowledge of fraudulent practices by their former employers after they have been demoted or terminated for complaining to their supervisors about the fraudulent practices or leaving their employment because they refuse to participate in the fraud.

Legal basis: 31 U.S.C. § 3730(b) (qui tam provisions) | Source: uscode.house.gov

YOUR PROTECTIONS AS A WHISTLEBLOWER

When you file a qui tam complaint, it is submitted under seal and served on the Department of Justice and any state agencies that have been impacted by the alleged fraud. During the time the case is under seal, your employer is not notified and does not receive a copy of the complaint. Your identity remains protected throughout the government’s investigation.

The False Claims Act prohibits your employer from firing, demoting, suspending, harassing, or otherwise retaliating against you for reporting fraud or participating in a qui tam case. These anti-retaliation protections apply to both current and former employees.

If your employer retaliates against you, you have legal remedies that include reinstatement, two times the amount of back pay owed, interest on that back pay, and compensation for special damages including litigation costs and attorney fees.

Legal basis: 31 U.S.C. § 3730(h) (anti-retaliation) | 31 U.S.C. § 3730(b) (under seal filing) | Source: uscode.house.gov

WHISTLEBLOWER REWARDS

When a qui tam lawsuit results in a financial recovery, the False Claims Act entitles the relator to receive a percentage of the total amount recovered by the government. If the government intervenes and takes over the case, the relator may receive between 15% and 25% of the recovery. If the government declines to intervene and the relator proceeds independently, the share can rise to between 25% and 30%. There is no cap on the dollar amount of the reward. We work on a contingency fee basis. There is no upfront cost, and if there is no recovery, you owe us nothing.

Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2) | Source: uscode.house.gov

About This Practice

Arvind Bob Khurana has over 27 years of experience in qui tam and False Claims Act litigation, complex commercial litigation, and class action matters. He began his career at a top international defense firm and joined a national class action firm in 2005, becoming partner in 2009, where he worked on ERISA actions, qui tam cases, securities fraud, and antitrust matters. He is admitted to the New York State Bar and represents whistleblowers in federal courts nationwide.

We are selective. Before we ask for any commitment, we investigate the claim, explain the facts and the risks, and give you a complete picture of what you are facing. We never ask you to sign a retainer agreement until you have the full picture and have decided, on your own terms, that you want to move forward. You remain in control throughout.

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Arvind Bob Khurana has over 27 years of experience in complex litigation. We work on contingency. There is no upfront cost and no obligation to proceed.