November 12, 09

NEWS / Oregon Hospice Pays U.S. $1.83 Million to Settle False Claims Act Liability

WASHINGTON — Kaiser Foundation Hospitals - Kaiser Sunnyside Medical Center, Kaiser Foundation Health Plan of the Northwest and Northwest Permanente P.C., Physicians & Surgeons (collectively, Kaiser NW) has agreed to pay the United States $1,830,322.41 to settle False Claims Act liability, the Justice Department announced today. The United States contends that Kaiser NW billed Medicare between 2000 and 2004 for hospice services that had been provided by the Kaiser Northwest Region Hospice without obtaining written certifications of terminal illness required under the federal health care program.

Medicare hospice care providers like Kaiser Northwest Region Hospice must obtain written certifications of terminal illness for each hospice beneficiary’s initial certification period (the first 90 days of care) from the medical director of the hospice and the individual beneficiary’s attending physician, if the beneficiary has one. Medicare requires a hospice to obtain these certifications prior to billing Medicare in order to help ensure that hospice care is medically necessary.

In June 2005, Kaiser NW submitted a report to the Department of Health and Human Service’s Office of Inspector General disclosing that between October 2000 and March 2004, there were instances in which Kaiser NW did not obtain written certifications of terminal illness for hospice beneficiaries prior to billing Medicare for the beneficiaries’ initial certification period. The settlement announced today resulted from the company’s disclosure.

"By requiring that health care providers comply with Medicare’s standards, we ensure that beneficiaries receive hospice care that is medically necessary and meets appropriate medical standards," said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. "We encourage disclosures of this nature and we consider them essential to ensuring the protection of the Medicare Trust Fund."

"This settlement furthers the strong public interest in protecting the integrity of the Medicare program and ensuring the appropriateness of hospice care for Medicare beneficiaries," said Kent Robinson, Acting U.S. Attorney for the District of Oregon.

The case was handled by the Justice Department’s Civil Division, the Acting U.S. Attorney for the District of Oregon and the Office of Inspector General of the Department of Health and Human Services.

http://www.justice.gov/opa/pr/2009/November/09-civ-1215.html