Dallas-based Hospice Provider Settles for Millions, Shining Light On Fraud in U.S. Healthcare

By Marlissa Collier Hospice care is a specialized care program intended for terminally ill patients with a life expectancy of six months or less. Medicare reimburses hospice providers at higher rates compared to traditional home health or nursing home care. The DOJ alleges that Elara Caring exploited this difference in reimbursement rates by improperly placing ineligible patients in hospice care to maximize profits. According to the DOJ, some of the Elara Caring patients in question lacked a terminal illness, a key requirement for hospice care eligibility under Medicare. Additionally, the government alleges Elara Caring failed to properly document the eligibility of some patients for hospice care. An internal audit conducted by Elara Caring in 2019 reportedly identified over a dozen instances of improper hospice care, but the company allegedly did not report these findings to Medicare. The settlement comes on the heels of a whistleblower complaint filed by a former nurse. The whistleblower alleged that the company pressured staff to place patients in hospice care regardless of their eligibility. Healthcare fraud is a persistent threat in U.S. healthcare, draining billions from the system. It’s estimated that between phantom billing (billing for services that are never performed), upcoding (assigning a higher-level...