A major regional hospice care provider settled with federal prosecutors late last month to end prosecution for allegedly submitting false claims to Medicare for patients who were not terminally ill.
Prosecutors from the U.S. Attorney’s Office for the Eastern District of Tennessee say Caris Healthcare admitted and recertified patients for hospice care who were ineligible for such treatment. They charge that, due to pressure from the company to meet intake standards, several patients were admitted to the company’s care who were suffering from conditions that were not likely to be terminal. Applications for Medicare benefits were submitted by the firm for care rendered for such patients, per the government, despite the patients’ non-terminal prognoses.
Per the government, Caris’s management eventually became aware of such problems, but no meaningful changes were made to rectify past erroneous billings nor prevent future ones. The situation ultimately came to light when a former employee sued Caris under the whistleblower provision of the False Claims Act (a/k/a the “Lincoln Law”), which the Justice Department pursued after investigating the allegations.
Though no determinations regarding the veracity of the claims against Caris were made in court, the company agreed to settle with the federal government for $8.5 million. Caris made no admission of guilt regarding the allegations, and it continues to operate branches in Tennessee, Virginia, and South Carolina.
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