St. Joseph Hospice entities operating 13 facilities across Mississippi, Louisiana, Texas, and Alabama paid $5.87 million for submitting false Medicare claims for continuous home care hospice services provided to patients who were not entitled to receive that higher level of care.

St. Joseph Hospice Network (MS/LA/TX/AL) — Continuous Home Care Fraud (2015)

Outcome: St. Joseph Hospice entities, operating 13 facilities across Mississippi, Louisiana, Texas, and Alabama, paid $5.87 million to resolve False Claims Act allegations that they billed Medicare for continuous home care hospice services provided to patients who did not qualify for that level of care.

Patrick T. Mitchell, majority owner and manager of the St. Joseph Hospice network, oversaw a chain of 13 hospice facilities operating across four southern states. The organization submitted false claims for "delivery of continuous home care hospice services to patients who were not entitled to receive continuous care hospice level treatment."

Under Medicare hospice regulations, continuous home care — the most expensive hospice billing category — requires that a patient be experiencing a period of acute medical crisis requiring sustained skilled nursing care for the majority of an 8-to-24-hour period. Billing continuous home care for patients not in crisis inflates Medicare costs while misrepresenting the actual level of care provided.

The settlement of $5,867,518 was resolved through the U.S. Attorney's Office for the Southern District of Mississippi and announced September 3, 2015. The multi-state scope and scale of the fraud — across 13 facilities — indicates systematic billing manipulation rather than isolated errors.

Primary Source: OIG Enforcement Record