by Ben Vernia | June 26th, 2018
On June 25, the Department of Justice announced that Caris Healthcare, L.P., based in Knoxville, Tennessee, had agreed to pay $8.5 million to settle allegations initially brought by a whistleblower, that the company submitted false claims, including for hospice care for patients who were not terminally ill. According to DOJ’s press release:
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, the Department of Justice announced today. 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 had previously received improper payments for these and other patients that should have been returned to Medicare.
* * *
The Government also announced that the whistleblower, a nurse previously employed by Caris, will receive $1,402,500 (a 16.5% relator’s share).
