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How Lawyers Beat Allegations of Hospice & Palliative Care Fraud

How Lawyers Beat Allegations of Hospice & Palliative Care Fraud

Hospice and palliative care fraud allegations can be scary for healthcare providers. But with the right legal defense, these allegations don’t have to ruin your business or career. As healthcare lawyers, we’ve successfully defended numerous hospice and home health agencies against fraud allegations. Here’s how we do it.

Understanding the Allegations

The first step is understanding exactly what you or your client is being accused of. Common allegations include:

  • Billing for services not provided
  • Providing unnecessary services
  • Kickbacks for patient referrals
  • Misrepresenting patient condition to qualify for hospice
  • Falsifying clinical records

While concerning, none of these allegations on their own mean definite guilt or exclusion from federal healthcare programs. With an experienced legal team, they can often be explained or disproven.

Assembling Your Hospice Fraud Defense Team

Fighting healthcare fraud requires specialized legal knowledge. You need a team experienced in the complex rules and regulations governing federal healthcare programs. This includes attorneys with extensive trial experience and consultants like nurses, doctors, and billing experts.

Some key players we involve:

  • Healthcare trial lawyers: Represent you before licensing boards, in civil False Claims Act lawsuits, in criminal proceedings, and more. They identify weaknesses in the government’s case and build your defense strategy.
  • Compliance consultants: Analyze your operations to ensure you have effective compliance programs in place and identify any weaknesses that need correction. This shows regulators you take compliance seriously.
  • Medical experts: Review patient records and attest patients were eligible for hospice with appropriate clinical indications. They refute allegations you “fudged” diagnoses.
  • Billing experts: Audit your billing records and provide expert testimony that your billing was appropriate for the services rendered.

Conducting an Internal Hospice Fraud Investigation

Before mounting a legal defense, it’s critical to conduct your own internal investigation. Analyze areas the government has questioned more closely. Interview employees. Review protocols. Dig into patient records. The goal is determining if fraud actually occurred, and if so, how widespread it was.

This serves several key purposes:

  • Uncovering any problem areas that do need fixing
  • Identifying weaknesses in the government’s case
  • Determining the extent senior management was involved
  • Developing insights to inform your legal defense

Building Your Defense Strategy

With a solid understanding of the allegations and results of an internal investigation, your legal team can develop targeted defense strategies. Common approaches include:

Arguing the Government Lacks Sufficient Evidence

In many cases, the government has limited evidence backing their allegations or relies too heavily on statistical analysis. Your attorneys can file motions contesting the evidence and pick apart flaws in their reasoning. If charges reach trial, expert witnesses can testify evidence doesn’t conclusively prove guilt.

Demonstrating Good Faith Efforts to Comply

You may not have realized certain conduct constituted fraud or had a misunderstanding of complex program requirements. Your attorneys present evidence showing you acted in good faith without intent to defraud federal healthcare programs. This can undermine allegations you “knowingly” committed fraud.

Seeking Alternatives to Exclusion

Even if some fraudulent conduct occurred, the government’s proposed punishment—permanent exclusion from federal healthcare programs—is overly harsh. Your legal team can negotiate alternatives like a corporate integrity agreement (CIA). CIAs allow you to continue participating in federal programs as long as you implement strict compliance reforms.

Questioning Witness Credibility

Whistleblowers or disgruntled former employees often spark fraud allegations. Their testimony serves as the foundation for the government’s case. However, these witnesses may have ulterior motives for making allegations like revenge or financial gain. Your lawyers can uncover background facts demonstrating witnesses lack credibility.

Presenting Contrary Expert Testimony

The government relies heavily on expert testimony to prove technical violations. Your attorneys can retain reputable experts to critique the government’s experts. Differing clinical opinions on patient eligibility, appropriate billing codes, medical necessity and other issues can undermine the prosecution’s case.

Negotiating a Favorable Settlement

Rather than risk an adverse verdict at trial, many fraud cases end in a settlement. An experienced legal team negotiates the most favorable terms possible, positioning you to continue operating with minimal disruption. This may involve:

  • Reduced fines and penalties
  • Avoided program exclusion
  • Limited repayment responsibility
  • Clear roadmap for reinstatement into government programs

Reaching a fair settlement allows everyone to avoid the expense and uncertainty of a trial while still holding violators accountable.

Why a Strong Defense Matters

Battling hospice fraud allegations is challenging but not impossible with an experienced team. A well-planned defense can defeat charges entirely or mitigate penalties so you can move forward. Get the right help to protect your business, license and reputation. Reach out for a free case assessment today.

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