Whistleblower: hospice provider rigged documentation to raise census

A civil lawsuit filed by a whistleblower against Caris Healthcare, headquartered in Knoxville, Tenn., alleges that Caris provided hospice care to some patients who were not eligible and collected Medicare reimbursements for those patients. Caris operates as a provider of hospice services in Missouri, Tennessee, Virginia, South Carolina and Georgia.

The suit, triggered by a nurse formerly employed by the company, alleges that employees were instructed to chart any illnesses or symptoms that supported a terminal classification and to ignore signs or symptoms that might indicate improvement, according to WJHL-TV. The scam, which occurred in 2013-2014, caused hospice patients to be recertified under Medicare’s “six months or less to live” clause to receive payment for hospice services even when it wasn’t appropriate, the lawsuit documents say.

There is no limit on the Medicare coverage for hospice services, as long as the patient is recertified periodically to secure continued eligibility. The coverage rule has created a tempting loophold for hospices in the past, resulting in millions of dollars in fines and restitution for fraudulent Medicare claims.

Hospice isn’t the only setting under federal scrutiny. In late June, the federal healthcare fraud strike force enacted its largest bust to date, involving 301 defendants across 36 federal districts and about $900 million in false Medicare claims.

“The wrongdoers that we pursue in these operations seek to use public funds for private enrichment,” said Attorney General Loretta E. Lynch after the strike. “They target real people—many of them in need of significant medical care. They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust—between doctor and patient; between pharmacist and doctor; between taxpayer and government—and pervert them to their own ends.”

Topics: Medicare/Medicaid