A month before Haven Hospice announced its affiliate, VNA and Hospice of the Florida Keys, will cease operating by Feb. 28, it agreed to pay a $5 million federal fine to resolve allegations it had billed the government for “medically unnecessary” services.
“Haven knowingly submitted false claims to the Medicare and Medicaid programs for medically unnecessary hospice care for certain patients who had lengths of stays greater than three years,” Acting U.S. Attorney W. Stephen Muldrow in Jacksonville said in a prepared statement.
Typically, federal health-care programs pay only for hospice care when patients are in a terminal condition and have a life expectancy of less than six months, prosecutors said on Dec. 21 by announcing the deal.
Haven this week said the Florida Keys hospice agency will shut down at the end of February due to continued financial stress only worsened by Hurricane Irma’s aftermath. The decision will leave the Lower Keys without any hospice services.
“No, the settlement does not relate to VNA/HFK closure,” said Patricia Vernon, manager of marketing and communications for Haven. “The VNA/HFK closure is 100 percent related to the financial sustainability of VNA/HFK.”
In December, Haven Hospice President Gayle Mattson said in a statement the settlement was to resolve the claims “without any admission of liability in order to avoid delay and the expense of litigation.” She added hospice care is a “complex and constantly changing industry” where it’s common to have differing interpretations of regulations.
Vernon released that same statement Friday when asked for comment on the federal settlement.
The total Haven agreed to pay was $5,085,024, after the government accused the Gainesville-based agency with either knowingly or recklessly failing to document a valid basis for the initial start of hospice care for 63 patients since June 1, 2011.
“Haven’s diagnoses were not adequately supported, or were supported only with inconsistent practitioner information,” prosecutors said. “Many patients failed to demonstrate objective indications of decline throughout their time in the company’s care, despite some being in hospice for nearly six years. Some patients had their hospice diagnoses changed after several years when they did not show decline under their original ‘terminal’ diagnosis.”
The settlement was based on Haven’s ability to pay, prosecutors added.
The settlement ended a lawsuit filed in U.S. District Court for the Middle District of Florida by a former employee of Haven Hospice, Dr. John Simons. Simons filed the suit under the whistleblower provisions of the federal False Claims Act. He was set to receive roughly $900,000 of the proceeds from the Haven settlement.
Haven serves patients in 18 other Florida counties.
Gwen Filosa: @KeyWestGwen