Gentiva, successor to Kindred at Home, has agreed to pay $19.428 million to resolve allegations that Kindred at Home and related entities (Kindred) knowingly submitted false claims and knowingly retained overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programmes.
Gentiva’s hospice operations, headquartered in Atlanta, include entities that previously operated Kindred at Home hospice locations under the names Avalon, Kindred, SouthernCare and SouthernCare New Beacon.
“The hospice benefit under Medicare and other federal health care programmes provides critical services to some of the most vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will ensure that this important benefit is used to assist those who need it, and not as an opportunity to line the pockets of those who seek to abuse it.”
The settlement resolves allegations made by the United States and the State of Tennessee in a consolidated complaint filed in 2021 against certain Kindred related entities alleging that, from 2010 until February 2020, the defendants knowingly submitted or caused to be submitted false claims for hospice services provided to Avalon hospice patients in Tennessee who were ineligible for the Medicare or Medicaid hospice benefit because they were not terminally ill.
The settlement also resolves the complaint’s allegations that the defendants improperly concealed or avoided Avalon’s obligation to repay those hospice claims.
In addition, the settlement resolves allegations that certain Kindred, SouthernCare and SouthernCare New Beacon hospice locations knowingly submitted, or caused to be submitted, false claims for hospice services provided to patients who were ineligible for hospice benefits under Medicare and other federal health care programs because the patients were not terminally ill.
Those hospice locations were Kindred’s locations in Warwick, Rhode Island; Beaumont, Texas; and Independence, Missouri; SouthernCare New Beacon’s location in Demopolis, Alabama; and SouthernCare’s locations in Daphne, Alabama; Mobile, Alabama; South Bend, Indiana; and Youngstown, Ohio. The settlement also resolves allegations that those Kindred, SouthernCare and SouthernCare New Beacon locations knowingly and improperly concealed or avoided obligations to repay the foregoing hospice claims.
Further, the settlement resolves allegations that SouthernCare New Beacon allegedly violated the Anti-Kickback Statute by willfully paying renumeration to a consulting physician, between October 1, 2016, and Oct. 1, 2022, to induce hospice referrals of Medicare beneficiaries to its Gadsden, Alabama, location. The settlement of those allegations stems from a voluntary self-disclosure made by New Beacon Healthcare Group LLC doing business as SouthernCare New Beacon Hospice.
The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded health care programs. It is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.
“Hospice provides vital care and support for terminally ill patients and their families. Medicare’s and TennCare’s eligibility requirements ensure that federal and state health care money is properly used to support hospice programs,” said U.S. Attorney Henry C. Leventis for the Middle District of Tennessee. “We are committed to holding accountable health care companies and providers who prioritize profits over patient care by ignoring these requirements.”
“This office remains committed to safeguarding public monies,” said U.S. Attorney Michael A. Bennett for the Western District of Kentucky.
“My office remains determined to ensure that federal funding for essential health care, like the hospice care at issue in this investigation, goes to the patients who need it, rather than to health care companies who seek to exploit those patients for profit,” said U.S. Attorney Zachary A. Cunha for the District of Rhode Island.
“Hospice care is special end-of-life care intended to provide comfort for terminally ill patients. The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis, not a hospice provider’s desire to increase profits,” said U.S. Attorney Todd Gee for the Southern District of Mississippi.
“Our office is committed to protecting federal healthcare programs like the Medicare hospice benefit from false claims” said U.S. Attorney Sean Costello for the Southern District of Alabama. “We will hold accountable any providers that abuse taxpayer dollars.”
“The integrity of hospice care is critical to the millions of patients receiving these services,” said Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG).
The Medicaid programme is funded jointly by the state and federal governments. As a result of the settlement announced Thursday, the federal government will receive $18,956,151.32, Tennessee will receive $448,800 and the State of Ohio will receive $23,618.68.
