A Pennsylvania hospice provider has agreed to pay almost $6 million to the federal government to resolve a whistleblower Medicare fraud lawsuit.

In two separate whistleblower complaints filed in the Eastern District of Pennsylvania, past employees of SouthernCare Inc. claimed that their former employer had submitted fraudulent hospice care claims to Medicare that were either medically unnecessary or lacked documentation, thereby illegally and unethically receiving funding from the Medicare program.

Both former employees, Dawn H. and Patricia B., brought forward their allegations under the qui tam provisions of the False Claims Act, provisions that allow citizens to file civil actions on behalf of the United States. In these cases, the private citizens may benefit from the claims they bring forward, if a company is forced to pay a fine or compensation for filing allegedly false claims.

For bringing claims forward against SouthernCare Inc., Dawn and Patricia will receive around $1.1 million dollars in recovery, and will share the amount between them.

Allegedly, SouthernCare provided hospice care services to patients who were not eligible for hospice, and claimed reimbursement from Medicare even though the patients were allegedly not eligible to have their care covered under the Medicare program.

Requirements to be eligible for hospice under Medicare include that the care must be “reasonable and necessary,” and a physician has to certify that a patient is not expected to live more than six months. The care provider must also provide certain documentation for the patient to be eligible to have hospice care covered under Medicare.

According to Dawn and Patricia, SouthernCare put patients who were not terminally ill into hospice care. Additionally, the whistleblowers say that the company admitted patients who did not have the necessary documentation to prove that they suffered from a terminal illness. The two former employees go on to argue that the company treated some of these patients for many years, racking up high Medicare costs for each patient along the way.

Dawn and Patricia’s whistleblower Medicare fraud lawsuit addresses cases at the company’s Pennsylvania facilities that took place between January 2009 and December 2014.

In a press release about the whistleblower Medicare fraud lawsuit, U.S. Attorney McSwain stated, “My office takes whistleblower allegations very seriously, and we will hold accountable anyone who defrauds taxpayers … The False Claims Act gives us a powerful tool to do just that.”

McSwain went on to thank Patricia and Dawn for bringing forward claims against SouthernCare, and for providing “essential assistance to the government.” He stated that whistleblowers like Patricia and Dawn help preserve government program funds.

Maureen R. Dixon, Special Agent In Charge for the Office of Inspector General of the U.S. Department of Health and Human Services stated that businesses filing fraudulent Medicare claims for hospice care harmed taxpayers who pay into Medicare, and also could harm the patients themselves.

She argued that if a patient is improperly placed on hospice care, the patient may not receive treatments that could help them recover, because hospice care is only designed to keep a patient comfortable at the end of their life.