Hospice chain Caris Healthcare has agreed to pay $8.5 million to settle allegations that it knowingly retained overpayments for patients that were ineligible for the Medicare hospice benefit.
Caris, which operates in Tennessee, Virginia and South Carolina, admitted patients who they knew were not eligible for Medicare payments because they were not terminally ill. The company was alerted to this by multiple internal audits and employee reports but continued to submit Medicare claims.
"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 overpayments,” said Chad A. Readler, acting assistant attorney general in the Justice Department’s civil division.
The fraud was reported by a whistle-blower who formerly worked as a nurse for Caris. She will receive a $1.4 million share of the settlement.