Healthcare lawsuits involving Medicare fraud in connection with elder care are appearing in the news almost daily.  Awareness of these cases is important to each of us as citizens and taxpayers (who usually get left holding the bag), but even more so as family members and loved ones of potential pawns in a dirty financial game.

Kaiser Health News is reporting that a large company called AseraCare, which operates across several states, is accused in a whistleblower lawsuit of actively recruiting and cycling patients through nursing home and hospice services in order to maximize Medicare payouts.

According to allegations in the lawsuit, AseraCare is owned by a company called Golden Living, which provides skilled nursing and other services in addition to hospice care.  Government attorneys claim that AseraCare employees were pressured into recruiting patients eligible for skilled nursing care (provided by Golden Living) for 20 days, during which time Medicare picked up the entire tab.  After 20 days, when the patients would be required to chip in for their care, AseraCare employees would enroll the patients in hospice, where AseraCare continued to be paid in full by Medicare.  AseraCare allegedly referred and re-referred the patients through skilled nursing care, rehabilitative therapy, home health care, and hospice care for as long as Medicare would continue to pay.

Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts.  However, it is alleged that between 48 and 79 percent (depending on the location) of AseraCare hospice patients were being discharged alive.  If this is true, it seems implausible that all of those patients were legitimate candidates for hospice care.  If Medicare determines that services were improperly charged, it will deny payment, leaving the patients and their families to deal with the bills.

For the record, AseraCare denies the allegations and claims that it has at all times adhered to applicable rules for admitting hospice patients.

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