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Times editorial: Hospice whistle-blowers' claims require thorough investigation

HPH Hospice, a nonprofit agency serving patients in Pasco, Hernando and Citrus counties, is a $61-million-a-year business with a separate real estate holding company and a fundraising foundation. It employs 900 full- and part-time workers, and pays its chief executive nearly $300,000 annually.

It is the definition of big business, more than twice the size of a Pasco-based counterpart, Gulfside Regional Hospice, with which it competes for market share in the industry of caring for terminally ill.

Both hospice agencies are now being scrutinized by state and federal authorities after a whistle-blowers' lawsuit contended widespread fraud against the publicly funded Medicare and Medicaid health care plans. Both HPH and Gulfside deny the accusations, calling them false and unfounded and said they welcome the outside reviews.

The two whistle-blowers, Heather Jo Numbers and Gregory Scott Davis, are former employees of HPH Hospice, but did not work at Gulfside. Their lawsuit also names 40 nursing homes, hospitals and assisted living facilities as defendants, contending they conspired to bolster their own bottom lines by accepting free nursing care from HPH Hospice in exchange for patient referrals.

The pair's Alabama-based law firm is no stranger to suing the hospice industry, having reached a $25 million settlement in a 2009 case. Numbers and Davis filed suit in 2010, but the case remained sealed until July and was detailed Friday in a story by Times staff writer Lisa Buie. Coincidentally, a similar federal whistle-blower lawsuit, handled by a different law firm, was filed this week in U.S. District Court in Orlando. In it, a former executive of a Central Florida hospice said he was discharged after warning that his agency could face severe financial penalties for overbilling Medicare, according to an account in the Orlando Sentinel.

The attorney for Numbers and Davis said the pair had nothing to gain by coming forward. That is a stretch. Litigants in whistle-blower claims are eligible to receive up to 20 percent of the money recovered by the government if the fraud allegations prove to be accurate.

Motivations aside, the charges in the lawsuit are worthy of review and the office of Attorney General Pam Bondi is correct to investigate. Combined, HPH Hospice and Gulfside Regional Hospice have $84 million annual budgets with nearly all of the revenue from Medicare, Medicaid and private insurance.

Accountability is mandatory in publicly financed health care and the standard is no different regardless if the provider is nonprofit or a for-profit agency. If the suit is a fishing expedition, then the hook will come up empty. But if double-billing and fraud existed, then taxpayers are entitled to repayment and hospice agencies will need to provide a full accounting to the public.

Times editorial: Hospice whistle-blowers' claims require thorough investigation 10/22/11 [Last modified: Saturday, October 22, 2011 11:41am]
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