Literature Review

‘Sharpen your game:’ Dombi tells hospices to step up in face of stricter government oversight McKnight's Home Care; by Adam Healy; 7/22/24The Centers for Medicare & Medicaid Services has hospice on its radar, and providers’ best safeguard against unwanted attention is to take oversight measures into their own hands, according to William Dombi, president of the National Association for Home Care & Hospice. “Sharpen your game before somebody knocks on your door,” Dombi said Monday during a press conference at the 2024 NAHC Financial Management Conference in Las Vegas. He recommended that hospice providers look internally to identify problems that could raise regulators’ alarms. An independent audit, he noted, could be helpful for spotting potential noncompliance... He later noted, “Hospices believe they’re compliant when they’re probably not.”

Youngstown hospice nurses help alert feds on alleged insurance fraud; company pays settlementMahoning Matters; by Erina Anwar; 7/26/24 ... The U.S. Department of Justice announced on July 17 that federal prosecutors had settled with Gentiva, formerly known as Kindred at Home, after more than 20 whistleblowers — including two hospice nurses from Youngstown, Ohio — alerted the government for alleged fraud. The [Youngstown] nurses, Jason Medved and Anthony Donnadio, will receive a portion of the payout for reporting the fraud at a Youngstown hospice via a lawsuit they filed in 2023 under the federal False Claims Act (FCA). “As registered nurses, Jason and Anthony owed a duty to their hospice patients first and foremost,” Janel Quinn, a principal of The Employment Law Group said. “They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery.”

Local whistleblowers help in federal hospice investigation CBS WKBN-27, Austintown, OH; by Patty Coller; 7/22/24 The parent company that operates a hospice provider in Austintown has agreed to a settlement in a federal lawsuit alleging that the local location, along with others in the southern part of the country, defrauded the government, according to federal prosecutors. Gentiva, formerly known as Kindred at Home, has agreed to pay $19 million to resolve allegations that it and other entities of Gentiva 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, according to Department of Justice. ... The Employment Law Group said in a news release that there were 20 whistleblowers in the case, including two from the Youngstown area involving SouthernCare, who helped to recover about $2.13 million in alleged fraudulent billing.

‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space Home Health Care News; by Joyce Famakinwa; 7/19/24 The home health industry has its very own boogeyman--the bad actor. However, there's a difference between providers that had made errors in claims ... [Subscription required to continue reading]

Kindred and related entities agree to pay $19.428M to settle federal and state false claims act lawsuits alleging ineligible claims for hospice patients U.S. Department of Justice - Office of Public Affairs; Press Release; 7/17/24 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 programs. 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. [Click on the title's link to continue reading.]

Glitzy Scottsdale couple jailed in $900M fraud Gilbert Sun News; by Tom Scanlon; 7/14/24 ... According to a federal indictment, “Alexandra Gehrke and Jeffrey King were charged for targeting elderly Medicare patients, many of whom were terminally ill in hospice care, for medically unnecessary wound grafts.” Gehrke – known to friends and associates as “Lexie” – and King allegedly filed $900 million in fraudulent claims, pocketing “$330 million in illegal kickbacks as a result of their fraudulent scheme.” According to the indictment, they were responsible for “allograft” bandages being applied frivolously to hundreds of patients, many of them dying. According to Gehrke’s LinkedIn profile, “APEX Medical is a national medical device distribution company. 

10 recent healthcare industry lawsuits, settlements Becker's Hospital Review; by Andrew Cass; 7/8/24... Here are 10 healthcare industry lawsuits, settlements and legal developments Becker's reported since June 26:

Long-term care providers among 193 criminally charged, $2.75 billion in fraud recoveries so far in 2024McKnight's Senior Living; by Kathleen Steele Gaivin; 7/1/24The Justice Department has recovered more than $2.75 billion in false claims against healthcare providers and charged 193 defendants so far this year in criminal cases through its 2024 National Health Care Fraud Enforcement Action, and many of the cases involve nursing homes, home health or hospice agencies, and assisted living providers, according to a Thursday report from the department’s criminal division.

DOJ slaps $20M opioid prescription penalty on OptumRx Fierce Healthcare; by Noah Tong; 7/2/24 OptumRx will pay $20 million to resolve claims the company violated the Controlled Substances Act by improperly filling certain opioid prescriptions, the Department of Justice recently announced. The agency claims OptumRx did not fill prescriptions correctly for "trinity prescriptions" like benzodiazepines and other muscle relaxants from April 2013 to April 2015. These prescriptions, which are addictive, may not have been “intended for legitimate medical use” and carry “significant risk of harm,” according to a news release. “Pharmacies providing opioids and other controlled substances have a duty under the Controlled Substances Act to ensure that they fill prescriptions only for legitimate medical purposes,” said Principal Deputy Attorney General Brian Boynton, head of the Justice Department’s Civil Division, in a statement. “The department will continue to work with its law enforcement partners to ensure that pharmacies do not contribute to the opioid addiction crisis.”

National Health Care Fraud Enforcement Action results in 193 defendants charged and over $2.75 billion in false claims United States Attorney's Office - Western District of Virginia, Charlottesville, VA; 6/27/24 The Justice Department today announced the 2024 National Health Care Fraud Enforcement Action, which resulted in criminal charges against 193 defendants, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 federal districts across the United States, for their alleged participation in various health care fraud schemes involving approximately $2.75 billion in intended losses and $1.6 billion in actual losses. In connection with the coordinated nationwide law enforcement action, and together with federal and state law enforcement partners, the government seized over $231 million in cash, luxury vehicles, gold, and other assets. 

Tapestry Hospice settles healthcare kickback claims for $1.4 million United States Attorney's Office - Northern District of Georgia; Press Release; 6/20/24 Tapestry Hospice of Northwest Georgia, LLC, and its owners and managers, David Lovell, MD, Stephanie Harbour, Ben Harbour, and Andrew Nall (collectively “Tapestry”), agreed to pay $1.4 million to resolve allegations that they violated the False Claims Act by entering into kickback arrangements with medical directors in exchange for referrals of hospice patients to Tapestry. “By entering into kickback arrangements, health care providers can cause doctors to make medical decisions that are motivated by financial gain, rather than the patient’s best interest,” said U.S. Attorney Ryan K. Buchanan. “Our office is committed to ensuring the accountability of health care providers who put their own financial needs ahead of their patients.” “The False Claims Act settlement in this case will hopefully be a deterrent to those who selfishly evade our federal healthcare programs for their own benefit,” said Keri Farley, Special Agent in Charge of FBI Atlanta. “The message is clear, the FBI will not tolerate companies operating corporate-wide schemes to illegally line their pockets.” 

Home health agency racked up $8.5 million through fraudulent claims, hired employees with criminal historyHome Heath Care News; by Andrew Donlan; 6/13/24The former owner of a home-based care company – based in the Cincinnati area – has been found guilty of fraudulently billing more than $8.5 million from Medicare, Medicaid and Veterans Affairs (VA) over a six-year period. From 2015 to 2021, Sharon Romaine Ward submitted at least 92,770 claims on behalf of Halo Home Healthcare to Medicaid, and received $8.4 million between 2016 and 2021. She also admitted that she concealed her ownership of that company because of a prior felony conviction.

Care provider to pay $14.9M over false claims involving assisted living communitiesMcKnight's Senior Living; Kimberly Bonvissuto; 6/10/24A chronic disease management provider will have to shell out $14.9 million over allegations related to false claims involving assisted living communities, memory care communities and group homes. Bluestone Physician Services of Florida LLC, Bluestone Physician Services PA of Minnesota and Bluestone National LLC of Wisconsin agreed to a $14.9 million settlement with the Justice Department. The federal government alleged that Bluestone knowingly submitted false claims to Medicare, Medicaid and TRICARE — the healthcare program for active duty service members and their families — for certain evaluation and management codes for services related to chronic care management of assisted living residents. The settlement agreement resolves allegations that Bluestone submitted “inflated” claims between Jan. 1, 2015, and Dec. 31, 2019, that did not support the level of service provided. The federal government will receive $13.8 million from the settlement, with more than $1 million going to the states of Florida and Minnesota.