Consumer Fraud

Whistleblower Key in Recovering $8.5 Million from Tennessee Hospice Provider

whistleblower 300 168 Whistleblower Key in Recovering $8.5 Million from Tennessee Hospice ProviderA Tennessee hospice provider will pay the U.S. $8.5 million plus interest to settle a whistleblower lawsuit brought by a former nurse who claimed the company defrauding Medicare and Medicaid with false claims.

The settlement resolves allegations lodged against Caris Healthcare L.P. by whistleblower Barbara Hinkle, a registered nurse who formerly worked for the hospice provider.  Ms. Hinkle sued Caris on behalf of the U.S. government under the whistleblower provisions of the False Claims Act.

According to the U.S. Attorney’s Office for the Eastern District of Tennessee, which helped prosecute the case, Caris sought and admitted patients into its hospice programs when the patients weren’t terminally ill and didn’t need hospice care.

Caris started billing Medicare and Medicaid for unnecessary hospice care in 2013 in a push to boost its profits, the whistleblower suit alleged. Most of Caris’ hospice patients are Medicare and Medicaid beneficiaries.

Caris operates about two dozen hospice locations in Tennessee, South Carolina and Virginia.

“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 U.S. Attorney’s Office said. The whistleblower complaint also alleged that internal audits, concerns raised by the company’s chief medical officer, and nurse employees who examined the patients all alerted Caris to the ineligibility of these patients, yet Caris took no action to correct the allegedly fraudulent practices.

U.S. prosecutors alleged that between 40 and 50 percent of Caris’ claims for Medicare and Medicaid reimbursement were “false or fraudulent.”

According to Knoxville’s WBIR 10 News, Ms. Hinkle alleged in her whistleblower complaint that she repeatedly recommended against admitting some patients to hospice based on her assessments.

“We have significant expertise in investigating hospice fraud, as this part of the country unfortunately has seen more than its share of these schemes,” said Office of Inspector General Special Agent in Charge Derrick L. Jackson. “When hospices increase their bottom lines by billing taxpayers for unneeded services, they are diverting money from vulnerable, terminally ill individuals. Worse yet, these patients may not be receiving care for medical needs that would otherwise be covered in a non-hospice setting.”

In recent years, litigation involving hospice providers has increasingly focused on the eligibility of patients to receive hospice services, the U.S. Attorney’s office said. Unfortunately for those harmed by these profit schemes, the necessity of the care provided to them comes to light years after the fact, the government said.

Ms. Hinkle will receive $1,402,500 (16.5 percent of the total recovery) as a whistleblower award for her role in helping the U.S. recover Medicare funds.