Feds Allege Hospice Owner Committed Fraud
An Illinois attorney and part-owner of a hospice is facing criminal allegations that he overbilled the Medicare and Medicaid programs by as more than $20 million.
Prosecutors announced a single federal healthcare fraud charge against 46-year-old Seth Gillman, as well as a charge of obstructing a federal audit.
Gillman is part owner of Passage Hospices in Lisle, Ill., and seven nursing homes in various parts of the state. Nurses employed by the hospice company would visit the nursing home patients either at the facilities or at private residents.
Prosecutors allege Gillman instructed his nursing staff to systematically upcode Medicare patients who already qualified for hospice care to allow them to qualify for general inpatient care. That classification pays four-and-a-half times the standard hospice rate, a difference of more than $520 per patient day.
Between 2006 and 2008, the nursing home connected to Gillman billed an average of $4,437 per month for hospice patients in general inpatient care. Such billings rose to nearly $1 million a month by 2011. Gillman also allegedly paid himself bonuses of more than $833,000 to himself between 2009 and 2011.
Overall, about 22% of the patients in the nursing homes owned or operated by Gillman were in hospice care for six months or longer, about double the nationwide average. One stroke patient who was in a nursing home operated by Gillman had 2,000 days of hospice bills. Another had more than 1,400 days of hospice billing, even though her son said she was in relatively good health almost to the time she died. Prosecutors also alleged that Passages paid kickbacks to eight nursing homes that kept hospice-eligible patients in general inpatient care.
The obstruction count alleges that Gillman and his colleagues altered patient files that were then presented to a contractor that conducts audits for the Centers for Medicare & Medicaid Services when fraud is suspected. Several Passages employees admitted to altering records in 2009 and 2010, according to federal officials.
Gillman was released on $150,000 bond on Jan. 27. A federal magistrate ordered him to stay away from Passages until the charges had been resolved.
