CHICAGO, Jan. 27 (UPI) -- The owner of an Illinois hospice company is accused of jacking up the level of care for patients in order to obtain millions in additional government payments.
Seth Gillman, 46, of Lincolnwood was charged with one count each of healthcare fraud and obstructing a federal audit in a criminal complaint filed Friday in U.S. District Court in Chicago.
Federal prosecutors allege Gillman engaged "in an extensive scheme to obtain higher Medicare and Medicaid payments by fraudulently elevating the level of hospice care for patients, many of whom resided at nursing homes he also controlled across the state," the U.S. attorney's office said.
"In many instances, the level of hospice care allegedly exceeded what was medically necessary or actually provided, including for some patients who did not have terminal illnesses or who were enrolled far longer -- sometimes for several years -- than the required life expectancy of six months or less.
Gillman, an attorney, is part-owner of Passages Hospice LLC, based in the Chicago suburb of Lisle, and is also the agent and secretary of Asta Healthcare Co., which operates Asta Care Center nursing homes in northern and central Illinois.
The charges allege that between August 2008 and January 2012, Gillman "trained and caused to be trained Passages nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care, resulting in higher payments per day, compared to routine care."
In 2012, Medicare's daily reimbursement for general inpatient care was $671.84, while the daily payment for routine care was $151.23.
Between 2006 and late 2011, about 22 percent of Passages' patients received more than six months of hospice care, with 28 patients receiving more than 1,000 days of hospice care, prosecutors said. In contrast, only 11.8 percent of all U.S. hospice patients in 2009 received hospice care for longer than six months, prosecutors said.
From January 2006 to late 2011, Passages submitted claims for nearly 4,800 patients and was paid about $95 million by Medicare and approximately $30 million by Medicaid.
Between July 2008 and late 2011, Passages was paid about $23 million by Medicare for general inpatient care services, in addition to Medicaid payments for general inpatient care service claims submitted on behalf of more than 200 patients.
Gillman also allegedly paid employees bonuses based on the number of hospice patients receiving general inpatient care. He allegedly paid himself bonuses totaling $833,375 between March 2009 and April 2011.
