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Verdicts & Settlements

Crossroads Billed for Hospice Services Despite No Terminal Diagnosis

— November 29, 2021

Crossroads Hospice settled DOJ allegations.

Crossroads Hospice, a company operating in both Ohio and Tennessee, has agreed to pay $5.5 million to resolve allegations that it violated the False Claims Act.  The False Claims Act is a federal law that imposes liability on anyone who attempts to defraud governmental programs.  Hospice care is meant to focus on comfort of an individual at the end of life and maintain quality of life as much as possible when a person has a terminal illness that cannot undergo continued medical intervention.

The allegations against Crossroads include “knowingly submitted false claims to Medicare for hospice services for patients who were not terminally ill,” the civil suit states.  Whistleblower claims were made by Leanne Malone, Jackie Burns and Angela Heck, former employees, as well as Dr. David Weber, a home health physician.

Medicare patients, who receive the governmental benefit at a certain age after retirement are able to receive hospice when they have a life expectancy of six months or less due to their illness.  However, according to the settlement, from January 1, 2012, to Dec. 31, 2014, Crossroads billed Medicare for patients with a diagnosis of dementia or Alzheimer’s disease at its Ohio and Tennessee facilities even though they did not receive a terminal diagnosis.

Crossroads Billed for Hospice Services Despite No Terminal Diagnosis
Photo by Kampus Production from Pexels

“Medicare’s hospice benefit provides critical terminal services that focus on palliative rather than curative care,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “This settlement demonstrates our continuing commitment to ensure that hospice services are provided to patients who truly need this care and that patients who are not terminally ill receive appropriate curative care.”

“This office is committed to pursuing providers who put profits ahead of patients,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. “We will continue to hold accountable those who abuse federal healthcare programs at the expense of the taxpayers.”

“The Medicare program provides older Americans with access to health,” said Acting U.S. Attorney Joseph C. Murphy Jr. for the Western District of Tennessee. “When frauds like this are committed by serviced providers, it effectively deprives older Americans of health care resources. Our office will continue to take steps to prevent frauds like this from taking place in order to ensure that the Medicare program’s resources are used effectively.”

“The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis and desire for palliative care, not a hospice provider’s desire to boost its profits,” said Special Agent in Charge Lamont Pugh III of U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Our agency is dedicated to safeguarding both the Medicare program and Medicare patients. This settlement reaffirms HHS-OIG’s commitment to holding accountable providers who knowingly submit false claims to Medicare.”

Crossroads Hospice of Dayton LLC, Carrefour Associates LLC, Crossroads Hospice of Cincinnati LLC, Crossroads Hospice of Cleveland LLC, Crossroads Hospice of Northeast Ohio LLC, and Crossroads Hospice of Tennessee LLC were all named as parties in the lawsuit.  The settlement resolves the claims without an admission of wrongdoing.


Crossroads Hospice Agrees to Pay $5.5 Million to Settle False Claims Act Liability

False Claims Act

Hospice Care Coverage

Crossroads Hospice To Pay $5.5 Million to Settle FCA Allegations

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