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Fired Nurse Files Lawsuit Against San Diego Hospice

— A nurse fired by San Diego Hospice filed a whistleblower lawsuit against the end-of-life care provider, alleging the hospice routinely admitted patients who did not meet Medicare eligibility.

The suit, filed in December but unsealed earlier this week, accuses San Diego Hospice of falsifying patient records by urging nurses to be “creative” in admitting patients who had declined hospice care or were not qualified for the care under Medicare guidelines.

The suit alleges that the hospice went as far as to institute an “open access” policy in 2005, which admitted “virtually all” patients referred, even if they did not meet Medicare admission guidelines.

This activity prompted a Medicare audit, which could result in the organization being forced to return millions in Medicare benefits. In the past year, the hospice, which was once a $83 million operation, downsized staff, closed its acute-care center, moved out of its Mission Valley offices, filed for bankruptcy and eventually closed its doors.

This month, the KPBS/inewsource Investigations Desk began a series detailing the business behind hospice care and the difficulty of determining when end-of-life begins.

The suit’s plaintiff is Lori A. Rachac, a registered nurse. According to the suit, Rachac was employed by San Diego Hospice intermittently for nearly a decade. She was disciplined and later fired in January 2011, partly over disagreements with the hospice’s “philosophy of admission criteria.” In February, the hospice received notice of the audit.

Rachac filed the lawsuit under the state and federal False Claims Act, which makes illegal any fraudulent claim made to the U.S. government, including Medicare. The government can join Rachac in the suit; the U.S. Attorney’s office has yet to make a determination on whether it will. Under the act, the government can impose penalties up to $11,000 per false claim submitted, and Rachac’s suit asks for additional damages.

Rachac’s attorney, Mark Schlein, and a spokesperson for San Diego Hospice declined comment on the suit.

Hospice providers receive about $150 per day from Medicare for each of its patients. But as care gets more expensive and patients live longer, Medicare is cracking down on who can receive the benefit. Right now, Medicare supplies payments to patients who are determined to have less than six months to live, but patients can be recertified.

San Diego Hospice CEO Kathleen Pacurar told KPBS in November the Medicare audit was related to “regulatory issues.”

"Did we fill the forms out right? Did we certify when a patient was coming on, that they were eligible for the hospice benefit? Were they at the point in their terminal illness that we were the right service for them?” Pacurar said.

San Diego Hospice announced its closure earlier this month, and Scripps Health will take over patient care. Pacurar had predicted the hospice might end up repaying Medicare tens of millions of dollars in benefits for ineligible patients. There are about 20 hospice providers in San Diego County.

Comments

Avatar for user 'jeremy_schaub'

jeremy_schaub | March 14, 2013 at 1:49 p.m. ― 1 year, 4 months ago

Rachac ought to be proud of herself. San Diego Hospice is the most Amazing organization to work for and as far as seeing patients cared for. SDH was the worlds best hospice and had programs that extended world wide. It trained the top Hospice/Palliative Care M.D's in the country and around the world. It served 1000 patients and had 800 employees. I'd like to personally thank Rachac for her angry vengful actions--which are unwarranted from my inside knowledge of SDH. Rachac--you killed SDH. SDH is bigger than any manager or you. In killing SDH you put 800 people out of work--myself included. SDH was the most amazing place I've ever worked and acted with the utmost professionalism and expert care in all operations. It was the best medical organization, organization period, I've ever been associated with. It was a non-profit, no one was trying to rip off the government because no one could benefit from that. Being told to be "creative" simply means that sometimes people do qualify for service, but to follow the letter of the law one must turn over a few rocks by thinking creatively...it doesn't mean to make stuff up. It is the ethical responsibility of Hospice Staff to insure that no one who does qualify for service is rejected from service. Unfortunately the data isn't readily apparent and one must WORK a little and dig to put it all together. Often times to verify eligibility multiple tests are needed, and thorough examination of a patient's medical history/record is required to demonstrate a decline in health indicative of one that is likely to die within six months. But no one can predict death. I once heard a great M.D. state that all M.D.'s are not good at one thing: determining prognosis. Every person, every cancer, every heart disease etc. have similarities, but they also have differences which cannot be predicted. Why did Rachac kill SDH? Because she pulled the trigger on the gun--a gun that would put any hospice under because the medicare system is flawed. She appears to have done so out of bitterness. What kind of person goes after an amazing NON-PROFIT organization that helps people around the world and serves so many dying people at a level of quality that surpasses all others. Everyone experiences injustice, sometimes things happen that aren't fair--I've been there. Nevertheless Rachac seems to merely have been focused on herself and an attempt to cash in rather than do what any RN can do easily--get another job where you are wanted. I've been there...left...been terminated...had opportunity to bring law suits...but chose not to harm an entire organization who employees and serves numerous people...not based on the behavior of a few potentially fallible employees. No organization is perfect, because they are run by imperfect individuals. But SDH was a gem that changed the lives of many patients, families, and even employes.

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Avatar for user 'caravel'

caravel | September 30, 2013 at 8:52 p.m. ― 10 months ago

Jeremy, you are such a twisted and dishonest person. What you saying is that fraud and dishonesty does not matter in a company, you just want to be paid and cover the wrong doing with some selfish and lame reasoning. San Diego Hospice leading by Kathleen Pacurar, president and chief executive officer was directing a hospice to bankruptcy, due to wrong doing, how stupid you can be, a HOSPICE, people die every day, which is a business that won't run out of work and patients. You can excuse all you want but there is a POWERFUL REASON for the closing of San Diego Hospice, a legal reason and everyone knew what exactly they were doing, but greed was bigger than their intelligence. Good for Lori A. Rachac, RN, since she had the courage to confront Pacurar and their dogs. Pacurar should be the one responsible for what happen at San Diego Hospice; she is the one to blame in ALL aspects. I hope that one day justice will bring a piece for her and the ones behind such fraud, Hospice and Medicare Fraud!
But this is getting worse!!! NOW SHE IS WORKING FOR ELIZABETH HOSPICE!! WOW!
Elizabeth Hospice will get burn later on with Pacurar; she is bringing a lot of hit with her. Bad idea to hire Pacurar, because if she have to respond for her actions at San Diego Hospice, LEGALY, then her reputation will bring BIG PROBLEMS to Elizabeth Hospice, like the auditors again, she can bring another hospice to a closing and to bankruptcy.

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