ATLANTA—The executives of a hospice known as STG Healthcare of Atlanta have agreed to pay $1.75 million in a Medicaid/Medicare fraud settlement, Georgia Attorney General Chris Car announced today.
CEO Paschal “Pat” Gilley and CFO Matthew Gilley are accused of submitting false claims to Medicare and the Georgia Medicaid program, for patients who were not terminally ill and therefore ineligible for hospice care.
Two whistler blowers alerted officials about the false billings, spanning from 2013 to 2017. The Medicaid portion of the settlement is approximately $607,682 of the $1.75 million, officials said.
Former STG Healthcare employees Serita Samuel and Miranda Eskridge. Samuel and Eskridge filed a lawsuit in the Northern District of Georgia in 2016 as whistleblowers under the provisions of the Federal False Claims Act and Georgia False Medicaid Claims Act. The Georgia False Medicaid Claims Act awards treble damages and civil penalties for the submission of false claims to the Georgia Medicaid program.
Attorney General Carr praised the work of investigators.
“The hospice benefit provided by Medicaid is especially reserved for terminally ill Georgians at a critical time of transition in their care,” said Carr. “Our office is proud to have worked alongside the U.S. Attorney’s Office for the Northern District of Georgia in this effort, and we will continue to ensure the hospice benefit is not exploited and abused by health care providers to the detriment of Georgia taxpayers.”
STG Healthcare, doing business as Interim Healthcare of Atlanta, operated a hospice business serving the Atlanta area. The Medicaid Fraud Division of the Georgia Attorney General’s Office in conjunction with the U.S. Attorney’s Office for the Northern District of Georgia investigated allegations that STG Healthcare falsely billed the Georgia Medicaid program for hundreds of claims beginning in 2013.
“Hospice is not a blank check for unscrupulous medical providers willing to admit patients who are not terminally ill,” said U.S. Attorney Byung J. “BJay” Pak. “It is reserved for those who truly need it. We will also continue to prioritize cases where it appears that a medical decision, especially the decision to forego curative treatment, has been influenced by a kickback.”
The settlement resolved allegations that STG Healthcare submitted claims from 2013 to 2017 for patients who were ineligible for hospice care. The Medicaid hospice benefit is available for patients who have a life expectancy of six months or less. Also resolved were allegations that STG Healthcare unlawfully paid a physician in exchange for patient referrals to STG Healthcare’s hospice program. The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Georgia Medicaid Fraud Division Nurse Investigator Nancy Dickerson played a pivotal role in the investigation along with Investigators Laura Soto and Tonia Medlin. Chief Investigative Auditor Denise Colson also assisted in the investigation. The State of Georgia was represented by Assistant Attorneys General Sara Vann and Rick Tangum and former Assistant Attorney General Elizabeth White. The United States was represented by Assistant U.S. Attorney Austin Hall.