Phillips & Cohen partner Peter Chatfield provides the whistleblower’s perspective in a Medscape article about healthcare fraud in hospice care.
On the whistleblower side, attorneys will continue to face a tough burden in proving scienter ― that hospices knew or should have known about the false eligibility certifications or other errors, said Peter Chatfield, a partner at Phillips & Cohen in Washington, DC, who represents whistleblowers.
That requires showing damning patterns of behavior, such as vague diagnoses of patients, physicians signing off on certification requests from marketing staff without individual review, or a high percentage of patients who survive for a year or longer. It particularly helps when there is evidence of improper financial arrangements between hospices, physicians, and referral sources such as nursing homes.
The stronger the showing by the whistleblower of suspicious patterns of conduct ― apart from an outside medical expert’s testimony that the eligibility certifications were wrong ― the more likely the Justice Department will take on the case. That greatly improves the odds of winning a settlement or judgment.
Read the entire article, “Physicians Misjudge a Terminal Patient’s Life Span: Is It Fraud?” on Medscape’s website.