A hospice provider will pay $8.5 million to settle allegations with the government that it provided services to the non-terminally ill in homes and skilled nursing facilities.
Caris Healthcare — a for-profit hospice provider that operates in Tennessee, Virginia and South Carolina — reached the agreement with the Department of Justice, which said the provider submitted false claims and retained overpayments.
Caris had “aggressive” admissions and census targets, the DOJ said, and knew about the ineligibility of its payments through internal audits and complaints from executives.
The company “took no meaningful action” to figure out whether it received improper payments following those red flags, the government said.
“When a healthcare provider is put on notice that a patient is ineligible for a particular Medicare benefit or service, the healthcare provider cannot turn a blind eye to that information but, instead, must take reasonable steps to stop the improper conduct and to determine whether that conduct resulted in prior overpayments,” Acting Assistant Attorney General Chad Readler of the Justice Department’s Civil Division, said in the announcement.
In a statement issued Monday evening, Caris said that it disputes the allegations put forth by the DOJ, and it chose to settle now, rather than face the possibility of costly and protracted litigation. The company added that it is not admitting to any wrongdoing in agreeing to this settlement.
“Caris has the utmost confidence in its processes for determining patient eligibility for hospice and in the clinical judgment of those within our company on the frontlines of providing care to our patients,” Norman McRae, founder and Caris Healthcare board member, said in the statement.
Allegations were first made by Barbara Hinkle, a nurse formerly employed by Caris, who will receive $1.4 million of the settlement, according to the announcement.