Of all the kinds of government fraud that a whistleblower can call attention to, hospice fraud —making money by using dying patients to scam Medicare and Medicaid—can feel especially odious. Sometimes hospice providers even claim people are closer to death than they actually are in order to swindle us all out of our tax dollars.
Caris Healthcare, headquartered in Knoxville, TN, and which has seven SC locations, including one here in Columbia, is feeling the sting of fraud accusations because a former Caris nurse at the Bristol, VA, location blew the whistle. The 2014 federal complaint against Caris Healthcare, alleging that the company admitted and recertified patients who were ineligible for hospice services, was unsealed in June 2016. The False Claims Act complaint accuses the company of “systematic, long-lived, and continuing fraud, perpetuated through the Medicare and Medicaid programs.”
Caris Healthcare emphasized growing its hospice patient population in order to increase its bottom line. The Bristol location’s goal was 50 patients, but the location kept falling short, achieving only 20 to 40 patients. It is alleged that pressure to achieve the goal number meant that some patients were brought into the hospice program and repeatedly recertified for hospice benefits in order to keep the money flowing.
The nurse who brought the qui tam lawsuit claims that Caris employees were instructed to dig up any diagnosis they could in order to justify a link to a terminal illness requiring hospice care. The whistleblowing nurse has asserted that she was told to document only those symptoms that supported a diagnosis of declining health, and never to document improvements. By doing these things, the recertification that a patient had six months or less to live would continue without a hitch, thus extending hospice care and payments to Caris. Knowingly recertifying the terminal condition of a patient who is not terminal constitutes a false claim.
Court documents have alleged that between 40 and 50 percent of Caris’s claims to Medicare and Medicaid were fraudulent.
Medicare does not place a limit on coverage for hospice services, because it is admittedly difficult to predict with any accuracy when someone with a terminal condition will die. Herein lies the loophole in the system. Some people who are legitimately terminally ill need to be recertified because they live longer than expected. But recertifying someone who was never terminally ill in the first place, or whose diagnosis may not have been terminal, has resulted in past fraudulent care running into many millions of dollars.
The government has requested that the court freeze Caris Healthcare’s assets and that they be made to pay up to $11,000 per violation plus triple damages, in accordance with the provisions of the False Claims Act. The company has been accused of six counts of fraud by the U.S. government, and the losses are in the millions.
Because the case is still ongoing, there is no information concerning the award that the whistleblower will likely receive. Normally, awards are between 15 and 30 percent of the amount that is recovered in a successful suit.
Making a Difference
If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.
For a free, confidential evaluation of your case, call the Louthian Law Firm today at 1-803-454-1200 or, if you prefer, you can fill out our online contact form.