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Salt Lake County healthcare company to pay over $1 million for false claims to Medicare and Medicaid

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A healthcare company in Salt Lake County has agreed to pay more than $1 million to settle claims of submitting false claims to Medicare and Medicaid for non-covered hospice services. Summit Hospice was accused of knowingly billing for services that were not medically necessary, as the patients did not have the required documentation of a terminal illness to qualify for those services. This resulted in a violation of the False Claims Act between October 1, 2018, and September 7, 2021. Although the hospice center denied the allegations, it has agreed to pay a total of $1,045,944.42 to settle the claims.

According to the US Attorney’s Office in Utah, patients can only be eligible for Medicare hospice benefits if they have a medical prognosis stating that they are “terminally ill,” which means their life expectancy is six months or less if the illness runs its natural course. The investigation was conducted by the Office of Inspector General at the US Department of Health and Human Services and the Medicaid Fraud Control Unit at the Utah Attorney General’s Office.

Curt L. Muller, special agent with the Office of Inspector General, emphasized the importance of hospice care and said, “Providers who focus on personal financial gain rather than providing medically necessary, high-quality care to their patients undermine the integrity of these services.” Summit Hospice was accused of submitting false claims to Medicare and Medicaid for services that were not medically necessary, which is a serious violation of the False Claims Act.

In conclusion, the settlement of more than $1 million agreed by Summit Hospice is a consequence of their alleged violation of the False Claims Act by submitting false claims to Medicare and Medicaid for non-covered hospice services. The investigation was conducted by the Office of Inspector General at the US Department of Health and Human Services and the Medicaid Fraud Control Unit at the Utah Attorney General’s Office. The hospice center was accused of billing for services that were not medically necessary as the patients did not have the required documentation of a terminal illness to qualify for those services. Although Summit Hospice denied the allegations, it agreed to settle the claims by paying a total of $1,045,944.42.

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