In The News

Healthcare Provider Agrees to Pay $8.5 Million to Settle False Claims Act Allegations

A recurring theme in the government’s efforts to crack down on fraud and abuse, is companies who either out of intent or carelessness, fail to establish audits that can detect over payments from Medicare and other agencies. This was proven to be true when late last month, the Justice Department announced that Caris Healthcare, LP and its subsidiary, Caris Healthcare, LLC., have agreed to resolve allegations that the companies violated the False Claims Act when they submitted false claims, overcharged patients and improperly referred patients for hospice benefits who were not terminally ill. Caris Healthcare operates in Tennessee, Virginia and South Carolina. The government complaint alleged that Caris continued to submit hospice claims for patients even after concerns were raised by its Chief Medical Office and nurse employees who actually examined the patients in question. Moreover, the government also alleged that Caris took no action to determine whether it had received improper payments in the past that should have been returned to Medicare. Finally, the government alleged that Caris engaged in these behaviors in order to meet aggressive admissions and census targets that it set for itself.

“Today’s settlement is an important reminder that compliance programs and activities cannot exist in name only. When a healthcare provider is put on notice that a patient is ineligible for a particular Medicare benefit or service, the healthcare provider cannot turn a blind eye to that information but, instead, must take reasonable steps to stop the improper conduct and to determine whether that conduct resulted in prior over payments,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “Moreover, when internal audit results or other information reveals the existence of a compliance issue that is not limited to a particular claim, as was the case here, it is incumbent on providers to exercise due diligence to determine how widespread the problem is and to return any over payments.”

“It is completely unacceptable for providers to retain over payments from Medicare after being put on notice of the likelihood of such over payments. 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 settlement resolves allegations that originated from a lawsuit filed by Barbara Hinkle. Hinkle is a registered nurse who formerly worked for Caris Healthcare. Hinkle filed her suit under the qui tam, or whistleblower, provisions of the False Claims Act. This act permits private individuals to sue on behalf of the government, with or without the aid of a False Claims Act attorney, for false claims and to share in any recovery. A whistleblower law firm employs experts who are knowledgeable in all areas of the False Claims Act.