WASHINGTON, D.C. — The Department of Justice (DOJ) has reached a $8.5 million settlement with Caris Healthcare LP, along with its subsidiary Caris Healthcare LLC, after a whistleblower alleged the company submitted false claims and retained payments for patients ineligible for Medicare hospice benefits.
According to the DOJ, a former nurse who worked for Caris Healthcare, which operates in Tennessee, Virgina and South Carolina, alleges the company admitted and recertified patients to hospice care who are not illegible for the benefit as a way to meet the company's census target.
“[This] settlement is an important reminder that compliance programs and activities cannot exist in name only," Chad Readler, acting assistant attorney general for the DOJ's Civil Division, said in a statement.
Also according to the department, Caris allegedly continued the practice of submitting hospice claims even though it was made aware of the ineligibility of the patients through internal audits and by its chief medical officer and nurse employees.
"When a health care provider is put on notice that a patient is ineligible for a particular Medicare benefit or service, the 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 overpayments,” Readler said.