Geisinger Agrees to $18.5 Million Hospice Claims Settlement

Home health and hospice provider Geisinger Community Health Services has agreed to pay more than $18.5 million to resolve allegations of submitting claims to Medicare that violated the program’s rules and regulations. The company, part of the Geisinger Health System, recognized the issues on its own, took corrective action and notified the U.S. Attorney’s office, according to the U.S. Department of Justice.

Geisinger voluntarily disclosed to the U.S. Attorney’s Office that the organization submitted hospice and home health claims that were noncompliant with rules pertaining to physician certifications for hospice, patient election of hospice care, and physician face-to-face encounters for home health patients.

“The $18 million payment in this matter reflects the priority health care providers should place on making sure they closely follow all Medicare rules and regulations,” said Acting U.S. Attorney Bruce Brandler.

In addition to its home health and hospice services, Geisinger Health System cares for more than 1 million people throughout Pennsylvania out of nine hospital campuses, primary care centers, two research centers and a health plan with more than 500,000 members. The organization also established the Geisinger Commonwealth School of Medicine.

Hospice organizations are under increasing legal and regulatory scrutiny related to medical necessity complaints under the False Claims Act and the closely related anti-kickback statute. Documentation errors and omissions, live discharges and lengths of stay beyond six months are the main red flags that could bring regulators to a hospice’s doorstep.

The Department of Health and Human Services (HHS), Office of Counsel to the Inspector General (OCIG), the Justice Department’s Civil Division Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney  Tamara Haken of the Affirmative Civil Enforcement Unit for the Middle District of Pennsylvania worked with Geisinger to resolve the matter.

“Health care fraud remains a focus of the Department of Justice and the Affirmative Civil Enforcement Unit of the United States Attorney’s Office,” Brandler said. “I commend GCHS for taking this seriously, voluntarily disclosing these issues to our office and working to address the problems that led to these violations.”