JOHNSON CITY, TN (WJHL) – A U.S. Department of Justice complaint alleges some of Caris Healthcare’s patients remained in hospice care for multiple years. The recently filed federal court document stems from a False Claims Act case that a judge unsealed this summer.
The government alleges the hospice company admitted and retained patients who were not terminally ill, collecting millions in false Medicare claims in the process.
Prosecutors’ complaint identifies six patients who remained in hospice care for a combined 22 years. One of them, out of the Johnson City office, stayed in hospice care for more than five years, according to court records.
The complaint says a 2013 internal audit concluded five of those patients were not eligible for hospice care and the other patient’s eligibility was questionable. Despite that conclusion, the complaint says Caris continued filing claims for all of those patients. The six patients’ lengthy hospice experience allowed Caris to collect more than $1.2 million in Medicare funds up to that point, according to court records.
“While Caris Healthcare is not able to comment on the specifics of the allegations in the complaint, 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. “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 has the utmost confidence in both its processes for determining and documenting patient eligibility for hospice and in the clinical judgment of those within our company on the frontlines of providing care to our patients. We remain committed to the highest level of compassionate care to our patients and families so that patients live out their final days with dignity.”
National Hospice and Palliative Care Organization Senior Vice President Jonathan Keyserling could not talk about this case specifically, but did tell us predicting life expectancy is far from an exact science. He says medical directors also don’t have the benefit of hindsight.
“It’s only after the fact when the government comes in and looks at a blank chart or just the stark notes in the chart that they make any determination using hindsight on how long that patient should have lived,” Keyserling said. “Unfortunately, hospice medical directors and hospice physicians have to make ongoing decisions.”
Although Keyserling says just 10% of hospice patients live beyond six months, Medicare does not place a cap on a person’s length of care.
“There is no limit to the amount of time that a patient can be served by a hospice program, because there are ongoing eligibility tests the whole time that a patient is being served,” he said.
Caris says the federal government has now partially intervened in the lawsuit on behalf of a former employee. That employee has since asked the court to voluntarily dismiss the remaining claims in her original complaint that the government has opted against pursuing.Copyright WJHL 2016. All rights reserved.