Whistleblower Reward in $2.2 Million Hospice Fraud Case

A former Vice President of Clinical Operations for a hospice and palliative care facility has won a whistleblower reward after her former employer agreed to pay $2.2. million to resolve allegations that it filed false claims for reimbursement with Medicare.

In 2014, Cheryl Sifford filed a lawsuit “under seal” (i.e., in secret) against her former employer under the qui tam or whistleblower provisions of the False Claims Act.  Under that statute, a private citizen may bring a lawsuit on behalf of the government to recover for false claims and share in any recovery.  

Once a qui tam lawsuit is filed under seal, the government reviews the whistleblower’s evidence, conducts an investigation, and decides whether or not to pursue the claims.  If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered.

In this case, the whistleblower alleged that her former employer, Serenity Hospice and Palliative Care, knowingly submitted false claims for payment to Medicare for hospice patients.

The Medicare hospice benefit is available for patients who elect palliative care for a terminal illness and who have a life expectancy of six months or less if their illness runs its normal course.  Palliative care is medical care focused on providing patients with relief from pain, symptoms, or stress.  Once a Medicare patient is admitted to a hospice, he or she is no longer entitled to Medicare coverage for care designed to cure his or her illness.

The hospice in this case agreed to pay $2.2 million to resolve claims that it improperly certified patients as eligible for palliative care, pressured employees to admit patients for palliative care regardless of the patient’s prognosis, failed to maintain the proper paperwork to support claims for hospice care, and provided limousine rides, dinners and concert tickets to individuals in return for patient referrals.  The settlement resolved these claims without an admission of liability by Serenity or a concession by the United States that its claims are not well founded.

The amount of the whistleblower’s reward has not yet been determined, but it should be between 15% and 25% of the amount the government actually recovers, or between $330,000 and $550,000.

If you have evidence that a hospice or palliative care center is submitting false claims to Medicare, then you should consult with an experienced healthcare fraud whistleblower lawyer immediately to protect your rights.  You may be entitled to a substantial reward and legal protections as a whistleblower.

To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728.