Tennessee-based hospice care provider Caris Healthcare has asked a federal judge to toss a whistleblower’s False Claims Act lawsuit alleging the company admitted and retained patients who were not terminally ill, collecting millions in false Medicare claims for several years of unnecessary care.
The complaint, filed on behalf of the U.S. government in 2014 by whistleblower Barbara Hinkle, was unsealed in June after the federal government chose to intervene in the suit, effectively taking over its litigation. Government prosecutors chose to pursue some of the lawsuit’s claims, and the others were voluntarily dismissed.
Ms. Hinkle, a former nurse who worked at Caris in Bristol, Va., said during the admission stage that Caris instructed employees to find any diagnosis that would make the case for a terminal illness. This practice, she alleged, allowed Caris to admit more patients, keep them longer, and profit more from the Medicaid program.
The whistleblower lawsuit asserts that an internal audit of patient care conducted in 2013 by Caris, which operates 26 facilities in Tennessee, South Carolina, Virginia and Missouri, found that five patients were in ineligible for hospice care and a sixth patient’s hospice eligibility was questionable. However, despite those conclusions, Caris continued to file claims for those patients, the whistleblower suit alleges. In the case of the sixth patient, Caris collected more than $1.2 million from Medicare for hospice care that lasted several years, according to the complaint.
The lawsuit alleges that care for those six patients amounted to a combined 22 years.
The U.S. government accuses Caris of six counts of fraud. According to WJHL, “the plaintiffs are requesting a jury freeze the company’s assets and make Caris pay the United States up to $11,000 per violation” in addition to treble damages, which are standard under the False Claims Act.
According to WJHL, Caris maintains confidence in its processes and the clinical judgement of its employees in determining the need for hospice care.
Source: WJHL Tri Cities, Tennessee