Mention the word "hospice" and it brings to mind images of health care workers offering comfort to the terminally ill so they can die painlessly and peacefully.
But two former HPH Hospice employees paint a different picture: one of administrators falsifying paperwork to get more money from Medicare and Medicaid, admitting patients who were not terminally ill and who years later walked out alive, and giving kickbacks to hospitals and nursing homes in exchange for referrals.
"End of life care is the largest cost of the Medicare system," said James Barger, a partner in a Birmingham, Ala., law firm that is representing former HPH employees Heather Jo Numbers and Gregory Scott Davis. "There is a widespread misuse of this benefit."
Numbers and Davis filed the federal whistleblower lawsuit in April 2010, but it was sealed until July of this year. Their attorneys said the claims are also the subject of an investigation by the U.S. Department of Justice and the Florida Attorney General's Office.
Jennifer Davis, a spokeswoman for the attorney general, said the investigation was ongoing but declined to elaborate.
Tom Barb, CEO for HPH, said his nonprofit agency had not received the complaint but had turned over records to government agencies that requested them. He said an investigation would turn up no major wrongdoing, if any.
"We've been operating for 30 years with integrity," he said.
Among the allegations in the 42-page complaint:
• HPH management often instructed staff to keep patients even when they appeared to be stable rather than terminal and did not legally qualify for hospice payments from Medicare or Medicaid.
• Managers habitually instructed staff to keep patients during cold and flu season even when they were not terminal. "Regardless of the motive, this practice results in ineligible patients remaining on HPH's rolls — and being billed to the United States and State of Florida ... for weeks or months after they should have been discharged," the lawsuit says. "In fact, HPH's practice creates the real danger that stabilized patients in need of curative care will be denied curative treatment merely because their certification period falls between November and February."
• Employees fabricated patient forms to fraudulently revoke, then readmit patients who were not eligible for hospice care, "all with the goal of evading detection and getting future false claims paid," the lawsuit said.
• Staff admitted ineligible patients and then kept them on the rolls even when they planned to undergo aggressive treatment to try to cure their illness, which would disqualify them from hospice care.
• HPH provided free nursing care to hospitals, nursing homes and assisted living facilities in exchange for referrals to its programs. The lawsuit alleges these free services were "kickbacks." If the hospice had not provided this care, the cost would have had to be borne by the facilities.
• Medical charts were altered to show patients' conditions were declining, a practice known as "negative charting." HPH staffers "were consistently instructed (by managers) to perform negative charting to create a false impression that a stable patient was in a state of decline" so they could continue to get reimbursed for services, the lawsuit claims.
The allegations are focused on HPH, but the lawsuit also names Gulfside Regional Hospice as well as more than 40 area nursing homes, hospitals and assisted living facilities. Gulfside president and CEO Linda Ward said her agency recently became aware of the lawsuit.
"We plan to vigorously defend this action when and if we are served," said Ward, whose agency has operated since 1989.
Ward said Numbers and Davis had never been employed by Gulfside, "so how would they know" about its operations, she asked. She said the agency has had clean audits, and the suit would be shown to be "without merit."
Barb, the top executive at HPH, declined to comment on Numbers' and Davis' job performance, but confirmed they were no longer employed at HPH.
Attorneys for Numbers and Davis said their clients had nothing to gain by coming forward.
"It's only the bravest of us that risk giving up on their careers," Barger said, adding that both had resigned because "they couldn't stand by and watch taxpayers being defrauded."
Davis, a 19-year employee who had been a social worker and manager at HPH, "was one of the most trusted and valuable employees in that company," Barger said.
Barger, who along with his partners used to defend hospices and health care providers, said they decided to quit and join the other side. In 2009, they won a $25 million settlement with a small hospice organization.
"We believe in hospice the way Congress intended it," he said. "It's a great program. When it comes down to the corporate side, it's very ugly."