Former Hospice Owner Charged with Health Care Fraud

BIRMINGHAM—U.S. Attorney Joyce White Vance today announced the unsealing of an information and plea agreement charging a Muscle Shoals man with health care fraud totaling more than $3 million in connection to a hospice care program he operated.

Prosecutors charged JACKIE RANDOPLH GIST, 55, with engaging in a criminal conspiracy to defraud Medicare from about March 2006 to July 2009. During that time, Gist operated Good Samaritan Hospice USA Inc. (GSH), an Alabama corporation that provided hospice care in Muscle Shoals. Medicare’s hospice benefit program allows a beneficiary with a terminal illness to forgo curative treatment for the illness and instead receive palliative care, which is the relief of pain and other uncomfortable symptoms.

Gist’s scheme involved submitting claims to Medicare for amounts greater than warranted for the services provided, according to the charges and his plea agreement. The billing code which Gist caused GSH to submit to Medicare is generally used for services provided in an inpatient facility for pain control or acute or chronic symptom management that cannot be managed in other settings and is typically provided in the short-term. However, the services GSH provided were routine services, not inpatient services.

As a result of the scheme, GSH received reimbursements from Medicare totaling $4,108,924 when, if the correct code had been used, GSH would have been reimbursed $916,639. Accordingly, the fraud resulted in a loss to the Medicare program of about $3,192,285.

“In the span of just three years, Gist defrauded the Medicare program of almost $3.2 million,” Vance said. “Fraud such as this against the government will not be tolerated, and we will continue to aggressively enforce the law against individuals and companies who seek to take advantage of taxpayers,” she said.

This prosecution is part of President Barack Obama’s Financial Fraud Enforcement Task Force. President Obama established the interagency task force to wage an aggressive, coordinated and proactive effort to investigate and prosecute financial crimes. The task force includes representatives from a broad range of federal agencies, regulatory authorities, inspectors general, and state and local law enforcement who, working together, bring to bear a powerful array of criminal and civil enforcement resources. The task force is working to improve efforts across the federal executive branch, and with state and local partners, to investigate and prosecute significant financial crimes, ensure just and effective punishment for those who perpetrate financial crimes, combat discrimination in the lending and financial markets, and recover proceeds for victims of financial crimes.

The FBI and the Department of Health and Human Services - Office of the Inspector General, investigated the case. Assistant U.S. Attorney Lloyd Peeples is prosecuting the case.