Altus Healthcare & Hospice Settles Allegations of Inappropriate Use of Inpatient Hospice

ATLANTA—Altus Healthcare & Hospice Inc., n/k/a AHH Historic Inc., of Atlanta, Georgia, has reached a $555,572 settlement with the United States to resolve allegations under the False Claims Act that it submitted false or fraudulent claims to Medicare and Medicaid for inpatient hospice services, United States Attorney Sally Quillian Yates for the Northern District of Georgia announced today. Altus was acquired by Halcyon Healthcare in December 2011.

“The hospice benefit is intended to provide end-of-life care to terminally ill patients,” said United States Attorney Sally Quillian Yates. “When a hospice bills Medicare and Medicaid for more expensive services than are warranted, it diverts funds that could be spent caring for patients who truly need that level of care. We will continue to protect health care dollars to care for those in need.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, stated, “Federally funded programs such as Medicaid and Medicare provide a crucial service to those in need, certainly those requiring the services of a hospice, and the funds associated with these programs need to be protected from those who would engage in fraud, waste, or abuse. The FBI, in working with its various law enforcement partners and federal prosecutors, is determined to provide that protection of these federal funds.”

“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.”

Medicare and Medicaid beneficiaries are entitled to hospice care if they have a terminal prognosis of six months or less to live. There are four levels of hospice care, each of which are reimbursed at four different per diem levels. General inpatient care provides the second highest level of reimbursement. To qualify for general inpatient care, a patient must need pain control or acute or chronic symptom management that cannot be managed in other settings. The government alleges that Altus submitted false claims to the Medicare and Medicaid programs for general inpatient hospice care for patients who did not qualify to receive that level of hospice care during the period from March 1, 2008 through October 29, 2010, for the Medicare program; and during the period from March 1, 2008 through October 23, 2011, for the Medicaid program.

The civil settlement resolves a lawsuit filed by David C. Boal under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The case, pending in the Northern District of Georgia, is filed under United States ex rel. Boal v. Altus Healthcare and Hospice Inc., Drew Anderson, and Nora Tucker, No. 1:10-cv-1380 (N.D. Ga. May 7, 2010). Mr. Boal will receive a share of the settlement payment that resolves the qui tam suit that he filed.

The United States’ settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department used to recover approximately $2.4 billion nationwide in fiscal year 2011 in cases involving fraud against federal health care programs. The Justice Department’s total health care fraud recoveries under the False Claims Act since January 2009 have been over $7.7 billion.

This case was investigated by special agents of the Federal Bureau of Investigation and the Office of Inspector General of the U.S. Department of Health and Human Services.

The civil settlement was reached by Assistant United States Attorneys Lena Amanti and Christopher J. Huber.