In civil lawsuits, people frequently have their depositions taken. A deposition is a question and answer session under oath between a witness and at least one attorney. When the witness is testifying on behalf of one party, either the plaintiff or the defendant, Law Firm Jobs Near Me in Soweto the opposing party’s attorney will do most of the questioning. Usually, the lawyers for all parties are in the room, although not all of the attorneys present choose to ask questions. There is usually a court reporter present taking down what everyone says on a stenotype machine. There are many reasons for lawyers to take legal depositions.
Here are just a few. Rules The most prominent reason someone has to give a deposition is because a lawyer is not allowed to simply call up a witness for the other side and start asking questions. In fact, Auto Lawyers Near Me they are not allowed to speak to them about the case when that person has been designated as a witness for another party. Instead, it must be done in a formal setting. The witness is usually subpoenaed and the lawyer that has designated that person as a witness will usually be present.Information When an attorney believes someone has information that will lead to discoverable evidence in a civil case, they are allowed to take their deposition.
The witness is required by law to cooperate and answer fully and honestly any of the proper questions asked by the lawyers. Oftentimes, the lawyer may not know all of the important facts of the case. There may be people, objective third parties, who witnessed a car accident or that have factual information that is crucial to the case. Learning what they know about it may shed light on the case before it goes to court. This prevents one side from springing surprises on the other during trial.Intimidation On rare occasions, an attorney will take the deposition of a witness for the other side to intimidate or make the person nervous.
Hospice Fraud - A Review For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
This is more common in domestic dispute matters, such as child custody or divorce cases. It also happens more often to the plaintiff, Elder Care Lawyer Near Me the party bringing the lawsuit. This is sometimes done to make sure the witness knows the lawyer means business. Playing hardball in a deposition is what happens when the attorney is purposefully trying to make the witness uncomfortable. This may be done to make sure they tell the truth and to find out if the person will drop the case, rather than have to go through similar questioning in court, as well if the case goes to trial.
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Hospice fraud in South Carolina and the United States is an increasing problem as the number of hospice patients has exploded over the past few years. From 2004 to 2008, the number of patients receiving hospice care in the United States grew almost 40% to nearly 1.5 million, and of the 2.5 million people who died in 2008, nearly one million were hospice patients. The overwhelming majority of people receiving hospice care receive federal benefits from the federal government through the Medicare or Medicaid programs. The health care providers who provide hospice services traditionally enroll in the Medicare and Medicaid programs in order to qualify to receive payments under these government programs for services rendered to Medicare and Medicaid eligible patients.While most hospice health care organizations provide appropriate and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may result in the payments of large sums of money from the federal government, there are tremendous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As recent federal hospice fraud enforcement actions have demonstrated, the number of health care companies and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.A recent example of hospice fraud involving a South Carolina hospice is Southern Care, Inc., a hospice company that in 2009 paid $24.7 million to settle an FCA case. The defendant operated hospices in 14 other states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the company marketed to potential patients with the promise of free medications, supplies, and the provision of home health aides. Southern Care also entered into a 5-year Corporate Integrity Agreement with the OIG as part of the settlement. The qui tam relators received almost $5 million.Understanding the Consequences of Hospice Fraud and Whistleblower ActionsU.S. and South Carolina consumers, including hospice patients and their family members, and health care employees who are employed in the hospice industry, as well as their SC lawyers and attorneys, should familiarize themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have developed across the country. Consumers need to protect themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in health care fraud against the federal government because they may subject themselves to administrative sanctions, including lengthy exclusions from working in an organization which receives federal funds, enormous civil monetary penalties and fines, and criminal sanctions, including incarceration. When a hospice employee discovers fraudulent conduct involving Medicare or Medicaid billings or claims, the employee should not participate in such behavior, and it is imperative that the unlawful conduct be reported to law enforcement and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice employee from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may benefit financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States.Types of Hospice Care ServicesHospice care is a type of health care service for patients who are terminally ill. Hospices also provide support services for the families of terminally ill patients. This care includes physical care and counseling. Hospice care is normally provided by a public agency or private company approved by Medicare and Medicaid. Hospice care is available for all age groups, including children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to provide care for the terminally ill patient and his or her family and not to cure the terminal illness.If a patient qualifies for hospice care, the patient can receive medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. The hospice patient will have a team of doctors, nurses, home health aides, social workers, counselors and trained volunteers to help the patient and his or her family members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the comfort of their home, if the hospice patient's condition deteriorates, the patient can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.Hospice Care StatisticsThe number of days that a patient receives hospice care is often referenced as the "length of stay" or "length of service." The length of service is dependent on a number of different factors, including but not limited to, the type and stage of the disease, the quality of and access to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the median length of stay for hospice patients was about 21 days, the average length of stay was about 69 days, almost 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.Most hospice care patients receive hospice care in private homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice inpatient facilities (21%), and acute care hospitals (10%). Hospice patients are generally the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the diagnosis for almost 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by private insurance (8%), Medicaid (5%), charity care (1%) and self pay (1%).As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% increase over ten years. There were about 3,700 companies and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations. General Overview of the Medicare and Medicaid ProgramsIn 1965, Congress established the Medicare Program to provide health insurance for the elderly and disabled. Payments from the Medicare Program arise from the Medicare Trust fund, which is funded by government contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is the federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid.In 2007, CMS reorganized its ten geography-based field offices to a Consortia structure based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, survey & certification and quality improvement. The CMS consortia consist of the following:The FCA anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the employee (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking action to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination or retaliation, including litigation costs and reasonable attorneys' fees.A SC hospice fraud FCA whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the US Attorney General. After the disclosures are filed, a federal court complaint can be filed. The SC division where the frauds occurred, the relator's residence, and the defendant residence, will determine which division the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to decide whether or not to intervene. During this time, federal government investigators located in South Carolina will investigate the claims. If the case involved Medicaid, SC Medicaid fraud unit investigators will likely become involved as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is usually the lead attorney. If the government does not intervene, the relator's SC attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.Tips on Recognizing Hospice Fraud SchemesThe HHS Office of Inspector General (OIG) has issued Special Fraud Alerts for fraudulent and abusive practices of hospices. U.S. and South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be familiar with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. are:• A hospice offering free goods or goods at below market value to induce a nursing home to refer patients to the hospice. • False representations in a hospice's Medicare/Medicaid enrollment form. • A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the patient not been enrolled in the hospice. • False statements in a hospice's claim form (CMS Forms 1450, UB-04 or UB-92). • A hospice falsely billing for services that were not reasonable or necessary for the palliation of the symptoms of a terminally ill patient. • A hospice paying amounts to the nursing home for "additional" services that Medicaid considered included in its room and board payment to the hospice. • A hospice paying above fair market value for "additional" non-core services which Medicaid does not consider to be included in its room and board payments to the nursing home. • A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice. •A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare payment under the skilled nursing facility benefit, with the expectation that after the patient exhausts the skilled nursing facility benefit, the patient will receive hospice services from that hospice. • A hospice providing staff at its expense to the nursing home to perform duties that otherwise would be performed by the nursing home. • Incomplete or no written Plan of Care was established or reviewed at specific intervals. • Plan of Care did not include an assessment of needs. • Fraudulent statements in a hospice's cost report to the government. • Notice of Election was not obtained or was fraudulently obtained. • RN supervisory visits were not made for home health aide services. • Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained. • No Plan of care was included for bereavement services. • Fraudulent billing for upcoded levels of hospice care. • Hospice did not conduct a self-assessment of quality and care provided. • Clinical records were not maintained for every patient. • Interdisciplinary group did not review and update the plan of care for each patient.Recent Hospice Fraud Enforcement CasesThe DOJ and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.In 2009, Kaiser Foundation Hospitals settled an FCA lawsuit by paying $1.8 million to the federal government. The defendant allegedly failed to obtain written certifications of terminal illness for a number of its patients.In 2006, Odyssey Healthcare, a national hospice provider, paid $12.9 million to settle a qui tam suit for false claims under the FCA. The hospice fraud allegations were generally that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity Agreement was also a part of the settlement. The hospice fraud qui tam relator received $2.3 million for blowing the whistle on the defendant.In 2005, Faith Hospice, Inc., settled claims an FCA claim for $600,000. The hospice fraud allegations were generally that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.In 2005, Home Hospice of North Texas settled an FCA claim for $500,000 regarding allegations of fraudulently billing Medicare for ineligible hospice patients.In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, including violation of the AKS for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, settled an FCA suit for $2 million.ConclusionHospice fraud is a growing problem in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their SC lawyers and attorneys, should be familiar with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full compliance with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and FCA litigation.© 2010 Joseph P. Griffith, Jr.
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