A whistleblower lawsuit against Gentiva Health Services unsealed July 10 alleges the company defrauded Medicare by misclassifying home health care patients as hospice patients in order to boost reimbursements.
Alan Stewart, an Area Vice President with Gentiva, filed the complaint in 2014 under whistleblower provisions of the False Claims Act. He alleges Gentiva launched a “new financial plan” in 2013 that involved recoding many patients receiving home health care as hospice patients, even when those patients did not require hospice services.
According to McKnight’s, more than half of the patients who migrated from home health care to hospice care were not terminally ill and thus did not qualify for a Medicare hospice benefit. Medical records showed these patients had a “good or fair prognosis.” The majority of them also had a “good or fair rehabilitation potential,” McKnight’s reported, citing court documents.
Physicians had no knowledge of their patients’ transitions to hospice care, and Gentiva made “little to no effort to comply with Medicare conditions of payment or participation,” the whistleblower lawsuit alleges.
Mr. Stewart alleges that he expressed his concerns about Gentiva’s Hospice billings to company officials, but instead of addressing the problem, they dismissed his concerns and threatened his job. According to McKnight’s, one official told Mr. Stewart the hospice “is the most profitable line of business that Gentiva has and that home health is the pool of patients that we draw from.”
Mr. Stewart’s whistleblower complaint was unsealed in U.S. District Court for the Middle District of Alabama after the U.S. government declined to intervene in it. He has not decided whether to proceed with the lawsuit without the federal government’s assistance.
Gentiva and its parent company Kindred Healthcare Inc. told McKnight’s in a statement that they “dispute the allegations in this lawsuit” and will defend themselves “vigorously” from the accusations.