Home Health & Hospice Week

Ignore a hospice patient who has been on service for 5 years at your own peril.

If you disregard the findings of internal investigations — or even just stall on acting on them — you could face a steep penalty.

Case in point: Former Caris Healthcare employee Barbara Hinkle filed a qui tam lawsuit in 2014, alleging that the Knoxville, Tenn.-based hospice chain “billed the government for ineligible hospice patients between June 2013 and December 2013 and in relation to forty-five patients who were the subject of a Caris internal audit in June 2013,” Caris parent National Healthcare Corp. said in a November Securities & Exchange Commission filing.

Specifically, the whistleblower complaint unsealed in June alleged that Caris served six patients who remained on service for a combined 22 years, reports WJHL News. One Johnson City patient stayed on service for more than five years.

The complaint says a 2013 internal audit identified the billing problems for those patients, but Caris continued filing claims for them anyway, WJHL says. Caris collected more than $1.2 million in Medicare funds for the patients, according to court records. “Caris denies the allegations ... and intends to defend itself vigorously,” long-term care chain NHC says in the SEC filing.

“Caris Healthcare complies fully with the applicable laws and regulatory requirements concerning the determination and documentation of patient eligibility for the hospice benefit, and we fully expect that the facts will demonstrate that the government’s allegations are entirely without merit,” the company said in a statement shared with WJHL in October. “Caris maintains an extensive compliance program and remains confident in the steps that it takes to ensure the appropriateness of the reimbursement sought from all payers.” Caris operates 26 locations in four states.

Caris acquired Solaris Hospice in South Carolina in 2012 (see Eli’s HCW, Vol. XXI, No. 5). Murfreesboro, Tenn.-based NHC has a 75.1 percent non-controlling ownership interest in Caris.