Generally, nurses don’t want to see their patients take a turn for the worse. But Barbara Hinkle, a hospice care nurse, said she was repeatedly told by her supervisors at Caris Healthcare to “chart negatively”—basically, indicate a decline in health—even when patients’ conditions were stable.
Hinkle claimed she was directed to admit non-terminal patients and falsify or exaggerate medical charts throughout the 10 months she worked at the Bristol, VA location of Caris, a for-profit hospice care provider with 28 locations. The company also operates hospice centers in South Carolina, Missouri, Georgia and Tennessee.
The question is, why did Caris want to make it look like their patients’ health was worse than it really was?
According to a False Claims Act lawsuit initially filed by Hinkle in 2014, it was all part of Caris’ plan to defraud Medicare.
Anyone receiving Medicare Part A is eligible to get hospice care covered, as long as they meet two requirements: they must have a life expectancy of six months or less if their disease progresses as expected, and they must get a certification of terminal illness from a doctor. In theory, patients should only be in hospice for a few months, but Medicare will pay for this type of care virtually indefinitely.
After the initial six-month period, a doctor simply has to recertify that the patient is still terminal every 60 days, and the coverage will continue.
Reimbursement is based solely on what healthcare facilities report to the government. Like other hospice care centers, Caris was reimbursed for the number of Medicare patients it admitted. But unlike other facilities, Caris allegedly inflated this number by admitting patients who didn’t need hospice care and exaggerating their medical needs.
These allegedly fraudulent reimbursements racked up quickly over the years—the majority of Caris’ patients were (and likely still are) receiving Medicare or Medicaid, making it easy for company to bill for millions of dollars.
Internal Audits Suggested Rampant Deception at Caris
When she worked at Caris in 2013, Hinkle’s duties involved assessing patients for admission. She claims that she recommended against the admission of numerous patients, but Caris continued to pressure her to admit more people whether they were ready for hospice care or not.
Once patients were admitted, Hinkle was directed to chart negatively, even for the patients whose health hadn’t declined.
This scheme made it seem like Caris had many more Medicare-eligible patients than it did, and it seemingly allowed the company to bill for individual patients for months longer it should have. The lawsuit claimed that up to half of Caris’ claims were “false or fraudulent.”
Hinkle wasn’t the only person who knew about the purported fraud, either. The company’s Chief Medical Officer voiced concerns, and internal audits showed that patients were being admitted unnecessarily. But instead of being honest and changing admission procedures, the lawsuit alleged that Caris stuck to the status quo.
The facility never reported any of the violations it uncovered during its audits and it never paid back the false reimbursements it allegedly received.
Whistleblower Will Get $1.4 Million for Reporting Medicare Fraud
Seeing firsthand the unethical procedures that Caris had implemented, Hinkle became a whistleblower and filed a federal lawsuit in Knoxville, Tenn. in 2014. Two years later, the Department of Justice took up the case (which is allowed under the False Claims Act) and filed a civil complaint against Caris in October 2016.
After two years of negotiations, in June 2018 Caris agreed to pay $8.5 million in a massive settlement with the federal government.
Under the terms of the agreement, Caris has not had to admit any wrongdoing, and the company maintains that it hasn’t committed any fraud. In a statement, Caris said it decided to settle “to avoid the cost and uncertainty of continued litigation” and to “focus resources on providing high-quality palliative end-of-life care.”
However, whether Caris committed Medicare fraud or not, this $8.5 million settlement should be a signal that hospice care providers can’t abuse the system or their patients.
Because of Hinkle’s willingness to come forward, Medicare and Medicaid will get back some of the money it may have lost through Caris’ alleged fraud. Plus, Hinkle gets a benefit of her own: she will receive a portion of the settlement—about $1.4 million—as a reward for her honesty and courage.
Aside from numerous hospice centers across the country, hospice care is often provided by hospitals, nursing homes and in-home healthcare companies. It’s alarmingly easy for any of these providers to get away with fraud—as long as witnesses choose to turn a blind eye to it.
If you know of any hospice care providers committing Medicare, Medicaid or TRICARE billing fraud, one of our attorneys can help you report what you know. Like Hinkle, you may be entitled to a substantial reward. Use our confidential ONLINE REPORT FORM to learn your rights.