Caris Agrees to Pay $8.5 Million to Settle False Claims Act Lawsuit Alleging That it Billed for Ineligible Hospice Patients
Seattle Whistleblower Attorneys report that Caris Healthcare, L.P. and its wholly-owned subsidiary, Caris Healthcare, LLC (“Caris Healthcare”), have agreed to resolve allegations that they violated the False Claims Act by knowingly submitting false claims, and knowingly retaining overpayments, for the care of patients who were ineligible for the Medicare hospice benefit because they were not terminally ill. Under the settlement agreement, Caris Healthcare, a for-profit hospice chain that operates in Tennessee, Virginia, and South Carolina, has agreed to pay $8.5 million.
The settlement resolves allegations that Caris Healthcare admitted and recertified patients for hospice care that were ineligible for the hospice benefit. The government’s complaint alleged that, in an effort to meet the aggressive admissions and census targets set by the company, Caris admitted patients whose medical records did not support a terminal prognosis. The government’s complaint further alleged that when Caris was alerted to the ineligibility of these patients—via internal audits, concerns raised by its Chief Medical Officer, and recommendations of its nurse employees who actually examined the patients—Caris not only continued to submit hospice claims to Medicare for the patients, but also took no meaningful action to determine whether it ad previously received improper payments for these and other patients that should have been returned to Medicare.
The settlement resolves allegations filed in a lawsuit by Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case. The whistleblower’s share will be $1,402,500.This matter was handled on behalf of the government by the U.S. Attorney’s Office for the Eastern District of Tennessee, the Justice Department’s Civil Division, and the Department of Health and Human Services Office of the Inspector General.
The case is captioned United States ex rel. Hinkle v. Caris Healthcare, L.P., et al., Case No. 3:14-cv-212 (E.D. Tenn.). The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Source: Dept. of Justice
The settlement resolves allegations that Caris Healthcare admitted and recertified patients for hospice care that were ineligible for the hospice benefit. The government’s complaint alleged that, in an effort to meet the aggressive admissions and census targets set by the company, Caris admitted patients whose medical records did not support a terminal prognosis. The government’s complaint further alleged that when Caris was alerted to the ineligibility of these patients—via internal audits, concerns raised by its Chief Medical Officer, and recommendations of its nurse employees who actually examined the patients—Caris not only continued to submit hospice claims to Medicare for the patients, but also took no meaningful action to determine whether it ad previously received improper payments for these and other patients that should have been returned to Medicare.
The settlement resolves allegations filed in a lawsuit by Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case. The whistleblower’s share will be $1,402,500.This matter was handled on behalf of the government by the U.S. Attorney’s Office for the Eastern District of Tennessee, the Justice Department’s Civil Division, and the Department of Health and Human Services Office of the Inspector General.
The case is captioned United States ex rel. Hinkle v. Caris Healthcare, L.P., et al., Case No. 3:14-cv-212 (E.D. Tenn.). The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Source: Dept. of Justice