(LEGAFI) -- A former manager at Vistas Healthcare Corp. has filed a whistleblower lawsuit against the hospice chain accusing it of defrauding the government by conspiring with HMOs to enroll Medicare patients who weren't dying.

 

Vistas -- the largest U.S. provider of hospice care -- has reportedly attracted government scrutiny as its Medicare-covered patients have doubled to 1.1 million over the last 10 years.

 

In court documents unsealed last week, the government said it suspects Vistas of "an extensive scheme" to defraud Medicare and Medicaid of "hundreds of millions of dollars" by falsifying records and hospice certifications.

 

The newly unsealed whistleblower lawsuit was filed by Michael Rehfeldt, a former branch manager for Vistas in San Antonio, who is seeking damages for the government as a whistleblower under the federal False Claims Act. Under qui tam provisions of the Act, Rehfeldt stands to receive up to 30 percent of any recovered funds.

 

"False certifications, fraudulent billing and cost shifting to the United States constitute a widespread, systematic practice endemic to Vistas," Rehfeldt's whistleblower lawsuit states.

 

Rehfeldt, who left Vistas in 2009, also names as defendants two HMOs: WellMed Medical Management Group and Care Level Management LLC. Rehfeldt alleges Vistas conspired with the two HMOs to admit their unprofitable patients into hospice, even though they weren't facing imminent death and therefore were not eligible for hospice under Medicare rules. Medicare requires patients must have six months or less to live, certified by two doctors.

 

According to the Vistas Healthcare whistleblower lawsuit, the arrangement benefied Vistas by providing hospice patients, while allowing "the HMO defendants to dump non-profitable patients into hospice, regardless of their qualifications."

 

Rehfeldt says he told his bosses about the alleged misconduct, but they ignored him. He claims top Vistas executives knew about the illegal arrangement.

 

So far the government has not decided to intervene in the case, but says its investigation of the allegations will continue.

 

Vistas denies Rehfeldt's allegations.