Hospice, accused of "milking Medicare," settles with feds for half a million

Getting out from under this whistleblower suit will cost Altus Healthcare & Hospice Inc. of Atlanta $555,572.

It's a quick settlement: David C. Boal, joined by the U.S. Government, brought suit against Altus, its CEO Drew Anderson, and its director of nursing Nora Tucker in May.

In their complaint, Boal and the U.S. charged that Anderson, Tucker, and Altus rooked CMS by sending in claims that were "were not properly certified by the medical director of the hospice or the physician member of the hospice interdisciplinary group and the individual's attending physician before payment was requested," or "did not contain a physician-written narrative before payment was requested."

The charge that brought the feds in, according to the Government's Notice of Election to Intervene in Part, was that Altus sometimes charged for a higher level of care than was justifiable.

Patients "who did not require or receive care for acute or chronic symptom management which could not be managed in settings outside of an inpatient facility" were charged for as if they required such care, says the complaint.

The suit also alleged that some patients came to Altus' hospices with "no proper diagnosis or certification of a terminally ill condition."

Boal says when he brought this to the attention of his employers while he was at Altus, they assigned him "to less desirable positions and locations, terminated his employment with Altus, refused to pay him for accrued 'Paid Time Off,' failed to provide him all benefits to which he was entitled, and otherwise retaliated against him." As the whistleblower, Boal gets a piece of the settlement.

The case results in no legal finding against Althus.

“Altus Healthcare allegedly milked Medicare’s hospice benefit to increase their own profit as much as possible,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “The Office of Inspector General is committed to eliminating this greed from our nation’s health care system.”