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Kaiser Settles FCA Case for $1.8 Million for Hospice Billing Errors

Kaiser Permanente recently settled a False Claims Act (FCA) liability for over $1.83 million following self-disclosure of hospice billing errors. As reported in a November 12, 2009, press release issued by the U.S. Attorney’s Office for the District of Oregon, Kaiser Foundation Hospitals - Kaiser Sunnyside Medical Center, Kaiser Foundation Health Plan of the Northwest and Northwest Permanente P.C., Physicians & Surgeons (collectively referred to as “Kaiser”) agreed to the settlement after self-disclosing that Kaiser submitted some claims for services provided by Kaiser Northwest Region Hospice between October 2000 and March 2004 without first obtaining an initial written certification of terminal illness from the individual beneficiary’s attending physician and hospice medical director.

Federal regulations require hospices to obtain a written certification of terminal illness within two calendar days of the start of the benefit period; in the event a written certification cannot be obtained within two calendar days, you must obtain a verbal certification. In the case of the initial certification period, the written or verbal certification must be from the hospice’s medical director or physician member of the interdisciplinary group and the individual’s attending physician, if the beneficiary has an attending physician. For subsequent certification periods, the certification must be from the hospice medical director or physician member of the interdisciplinary group. In no event should hospices submit claims to Medicare before a written certification is received and signed by the appropriate physician(s). Otherwise, they run the risk of submitting improper claims, which may trigger FCA liability.

To help avoid such FCA liability within your hospice, you should review your policies and procedures regarding certification and recertification of terminal illness, ensure that you have effective certification tracking systems in place so that no claims are submitted prior to obtaining written certifications and re-certifications, and, in the event you discover billing errors through internal audits, discuss the implications of self-disclosure with your attorney prior to self-disclosing such errors.

© 2020 Poyner Spruill LLP. All rights reserved.National Law Review, Volume , Number 17
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