A settlement has been reached to resolve False Claims Act allegations against Caris Healthcare.
The allegations arose from a lawsuit that claimed Caris Healthcare L.P. and its wholly-owned subsidiary, Caris Healthcare LLC knowingly submitted 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.
According to the government, allegedly, 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. Furthermore, allegedly, when Caris was alerted to the ineligibility of patients, the hospice provider continued to submit claims and took no meaningful action to determine if it had received improper payments.
Reportedly, 40% to 50% of Caris' claims for payment were "false or fraudulent." These claims were paid by the government, thinking they were legitimate.
“It is completely unacceptable for providers to retain overpayments from Medicare after being put on notice of the likelihood of such overpayments. Under the law, providers must go beyond merely conducting audits and providing forums for employee concerns. Rather, when Medicare rule violations have been revealed, the provider must take meaningful action to correct them, including repaying Medicare for funds they improperly received. Such corrective actions are vital to the integrity of the Medicare program, and the U.S. Attorney’s Office will continue to use the resources available to it to ensure the government is properly reimbursed for funds it is owed,” said J. Douglas Overbey, U.S. Attorney for the Eastern District of Tennessee.
The whistleblower, Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, share of the settlement will be $1,402,500.
