Home Health & Hospice Week

The hot seat is getting even hotter for Elara Caring.

In addition to facing a high-profile wrongful death suit after one of its nurses was killed allegedly by a convicted sex offender patient (see story, p. 122), the chain has just settled a whistleblower lawsuit over hospice services for $4.2 million.

Specifically, Elara and its subsidiaries JHH/CIMA Holdings Inc., CIMA Healthcare Management Inc., CIMA Hospice of Texarkana, CIMA Hospice of East Texas, and CIMA Hospice of El Paso “have agreed to pay $4.2 million to resolve allegations that they … knowingly submitt[ed]false claims and knowingly retain[ed] overpayments for the care of hospice patients in Texas who were ineligible for the Medicare hospice benefit because they were not terminally ill,” the Department of Justice says in a release. The activity ranged from 2014 to 2021.

Former regional clinical director Aneko Jackson filed the qui tam suit in April 2020, according to the settlement agreement. In court filings, Jackson says that after taking the job in 2019, she found a score of patients lacked required election statements. When she informed her supervisors, they said they would have visiting staff backdate the necessary paperwork, she alleges. When she said that was illegal, she was rebuffed.

Elara didn’t return the overpayments and later dismissed Jackson’s attempts to discuss the situation. The company finally terminated her position after she brought the issue up at a meeting, she claims in the suit. A 2019 internal audit also found that Elara furnished ineligible services to more than a dozen patients, but court documents say Elara never reported the issue to Medicare, reports D Magazine in Dallas.

“We are very pleased with the result for our client and the taxpayers, and pleased that justice was served,” attorney Justin Sumner with Sumner Schick, who represented Jackson, tells AAPC.

The DOJ “will continue to ensure that this benefit is used to assist those who need it, and not to line the pockets of those who seek to abuse it,” Brian Boynton, head of the Justice Department’s Civil Division, says in the release.

“We will continue to pursue health care providers who jeopardize the integrity of hospice care by prioritizing illegitimate profit over medically necessary services,” add Deputy Inspector General for Investigations Christian Schrank of the HHS Office of Inspector General.

Elara responds by noting that the allegedly ineligible services at issue “were primarily provided under prior ownership,” according to an Elara spokesperson. The company formed in 2018 through the merger of National Home Health Care, Great Lakes Caring, and Jordan Health Services.

“No quality of care or patient care issues are involved in the allegations or settlement,” the spokesperson points out in a statement. “The civil action will be dismissed.”

Enticing Example For Whistleblowers

This case once again shows the power of the whistleblower.

“Settlements like this hold offenders accountable and encourage anyone who suspects fraud involving the Medicare program to exercise their protected rights as whistleblowers,” stresses U.S. Attorney Jaime Esparza in the release. And the feds continue to publicize that qui tam option.

For example: On May 8, the OIG pushed out notifications via listserv and X (formerly Twitter) saying this: “Recognizing that #whistleblowers root out waste, fraud & abuse, and protect public health and safety, federal laws strongly encourage employees to disclose wrongdoing.” The OIG adds that “Federal laws also protect whistleblowers from retaliation.”

Note: The settlement agreement is at www.justice.gov/opa/media/1350346/dl?inline.