Another Hospice Provider Charged With Overbilling Medicare and Medicaid

Passages Hospices, LLC of Illinois and its administrator and part owner, Seth Gillman were recently charged with overbilling Medicare and Medicaid for improperly keeping nursing home residents on hospice.  Mr. Gillman is also an agent and secretary of Asta Healthcare Inc., which operated the nursing homes in question .  According to the complaint, a high percentage (22 percent) of Asta nursing home residents received hospice services for more than six months.  In addition, the company is accused of unnecessarily elevating levels of care to general inpatient care which greatly increased Medicare reimbursement to Passages.  He is also accused of developing an incentive program which tied bonus compensation to elevated levels of care.  Gillman is also charged with obstructing justice by having employees of Passages alter patient files presented to a CMS auditor.

Over the last few years, the government has targeted many private hospice companies through audits and other means and has closely reviewed and scrutinized lengths of stay, as well as elevated levels of care.  Changes to the law which require face to face encounters to recertify individuals on hospice by physicians is just one of the steps the government has taken to attempt to combat what is perceived to be overbilling.

Hospice providers need to keep a close eye on documentation supporting hospice, recertification of hospice and meeting local area determinations for putting and keeping individuals on hospice.  The government is increasingly skeptical of lengths of stay beyond 180 days and elevating levels of care for residents in nursing homes.  Employees in hospice settings need to be regularly trained on documentation, as well as making sure the medical record reflects the criteria necessary to support hospice and or elevated levels of care on hospice.

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