Fraud Watch: Caris to Pay $8.5 Million in False Claims Settlement

Caris Settles False Claims Act Lawsuit for $8.5 Million

Caris Healthcare, L.P. and its wholly-owned subsidiary, Caris Healthcare, LLC, have agreed to pay $8.5 million to settle allegations they violated the False Claims Act by knowingly submitting false claims and retaining overpayments for patients who were ineligible for the Medicare hospice benefit because they were not terminally ill, the Department of Justice (DOJ) announced.

Caris Healthcare is a for-profit hospice chain that operates in Tennessee, Virginia and South Carolina.The government’s complaint alleged that Caris admitted patients whose medical records did not support a terminal prognosis.

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The complaint further alleged that when Caris was alerted to the ineligibility of patients, the hospice provider continued to submit claims and took no meaningful action to determine if it had received improper payments. 

Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, filed allegations in a lawsuit as a whistleblower. Under the False Claims Act, the whistleblower’s share will be $1,402,500.

Texas Doctor and Nurses Convicted in Home Health Fraud Scheme 

One physician and two nurses were found guilty of health care fraud in Texas, and one physician and one nurse guilty of conspiracy to commit health care fraud, for their roles in a home health fraud scheme topping $11.3 million, according to the DOJ. 

According to trial evidence, the defendants engaged in the scheme to defraud Medicare by submitting and causing the submission of fake and fraudulent claims through Timely Home Health Services, a home health agency, and Boomer House Calls, a physician house call company. 

Kelly Robinett, M.D., 70, of Denton County, Texas, and Kingsley Nwanguma, 47, of Dallas County, were each convicted of one count of conspiracy to commit health care fraud and three counts of health care fraud. Joy Ogwuegbu, 42, of Collin County, was convicted of four counts of health care fraud

The evidence showed Robinett, a doctor of osteopathic medicine, certified services that were often not provided for patients he had never seen, the DOJ stated. Ogwuegbu, a registered nurse, falsified nursing assessments. Nwanguma, a licensed vocational nurse, falsified nursing notes, making it appear as if Medicare beneficiaries were qualified for and were provided skilled nursing services, according to the DOJ.  

Written by Amy Baxter

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