Getting What Is Deserved


Hospice services are intended to help a person who has a terminal illness be more comfortable in their final days. During this difficult time as families plan for the death of their loved one, they rely upon hospice to help negotiate the inevitable. A brazen businessman from Illinois took advantage of his hospice company ‘s patients and charged Medicare for more than $90 million in hospice services that were not necessary or not provided over four years.

It ‘s important to note that many of this company ‘s patients were not in need of hospice care. (So I’m sure it was a good surprise to learn that they were not dying, but then a bad surprise to realize that they had been duped.)

The owner gave kickbacks to nursing home employees who referred patients to his hospice care company and gave nursing homes $250 per day for every patient that was elevated to general inpatient care (GIP). (He also gave himself a $75 kickback for every patient declared GIP). In addition to his $320,000 annual salary, he took $1.2 million in bonuses over two years. (As you might guess, his business grew and he used his profits on private airplanes, luxury sports cars, vacations and a daily cocaine habit.)

The businessman ‘s office was raided, he was indicted two years later, and his hospice firm closed their doors. But, this wasn’t the only business this fraudster ran. He also headed up a family-owned nursing home where a previous investigation failed to notify state officials that the company was housing sex offenders who molested elderly and disabled patients. (That ‘s a pretty big detail to miss. Perhaps someone got a big bonus to keep quiet?)

The former hospice company owner pleaded guilty to one count of health care fraud. He received a sentence of six-and-a-half years and agreed to pay $18 million in restitution. (Nine million of that amount will go to repay Medicare.)

While there was significant monetary harm, there was also an enormous amount of emotional harm done in this scheme. It was reported that the fraudster berated and fired employees who challenged him with whistleblower lawsuits. One victim stated that she had been told that her sister, who was blind, deaf and mentally ill, had weeks to live because of esophageal cancer. (It turns out that she had treatable thyroid cancer.) When the company shut their doors, many of its employees were left unpaid and without support to care for their patients who actually needed hospice care. This fraudster ‘s patients and employees did not get what they deserved, but it looks like he deserves every bit of the sentence that he received.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Is this the Meanest Man in America?,” published on on March 15, 2017.

It wasn’t the biggest Medicare fraud case ever to make the news, but it may be one of the most brazen.

Illinois businessman Seth Gillman gave kickbacks to nursing home employees to designate patients for his hospice care company, even though many of them weren’t dying, according to federal prosecutors. Then his company, Passages Hospice LLC, charged Medicare for hospice services that weren’t delivered or weren’t needed ‚Äî more than $90 million worth of services from 2008 to 2012.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.