Tennessee Hospice Company Sued for Medicare/Medicaid Fraud

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Published June 4, 2021

The federal government has joined Tennessee in a lawsuit against Nashville-based Avalon Hospice, the state’s largest hospice company. The suit claims that the company filed false Medicare and Medicaid claims for patients who were not eligible for the benefits.

Tennessee Capitol Building in Nashville

While the U.S. Attorney’s Office just announced this week that it planned to join the suit, the company has actually been subject to a federal investigation for over a decade. The original complaint was brought to light by whistleblower testimony.

According to the lawsuit, Curo Health Services, which oversees Avalon Hospice, has been filing false claims for hospice services since 2010, all while knowing that the patients were not eligible for the benefits. An original lawsuit was filed in 2013.

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The suit also says that Avalon hid the knowledge that overpayments needed to be paid back.

“Even after the defendants were made aware through internal complaints and audits that they had billed for hospice services provided to Medicare or Medicaid beneficiaries who were not hospice-eligible, they did not return Medicare or Medicaid payments they had received,” according to the lawsuit.

It further claims that Avalon had a policy that used “aggressive financial targets and incentives” to increase the number of admittances into hospice programs, “while simultaneously discouraging the discharge of patients who were no longer eligible for the Medicare or Medicaid hospice benefit,” according to the information released by the U.S. Attorney’s Office.

The suit also alleges that Avalon withheld information or provided inaccurate information about patients’ conditions to some doctors who treated the patients or confirmed their eligibility for the benefits.

The government has asked for repayment of at least three times the amount that was falsely claimed, plus an additional $10,000 for each false claim.

Tennessee’s whistleblower protection laws also make allowances that may give a portion of those damages granted by the court to the two former employees who reported the activity.

The suit also mentions Regency Health Care Group of Brentwood. At this time, parent company Curo Health Services has not responded to the most recent version of the lawsuit.

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3 thoughts on “Tennessee Hospice Company Sued for Medicare/Medicaid Fraud

  • June 4, 2021 at 7:45 pm
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    My mother is a client of Avalon Hospice, they have been amazing in helping my wife and I care for Mom. I can only guess at what is going to happen as the pendulum swings hard the other direction for people that qualify for Hospice can’t get it. All the while massive amounts of federal money is spent on non-citizens.

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  • June 4, 2021 at 8:38 pm
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    Any idea what the total over payment was? Simply want to compare the amount to the improper billing by Cherokee Health Services of Knoxville. Over 7 Million dollars during a four year period. In addition to incentive payments over 2 million. They were given a pass, no fines no investigation, they were given five years to repay the over payment while still conducting business with TennCare. They are paying their board members in excess of 5 million dollars in compensation. The head of the organization provided “expert” testimony before the US Senate regarding medical billing. TennCare has no interest in providing any details regarding why. Employees within the organization were routinely treated to political rhetoric regarding the fitness of President Trump. As a registered non-profit political activity is prohibited, yet a matter of routine via an internal newsletter distributed with monthly pay statements.

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  • June 7, 2021 at 10:42 am
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    Well, Well, Well just another scam on our Seasoned Citizens via our Medicare/Medicaid system. Unfortunately Tennessee has created many of the issues with laws that provide advantage to one segment or another in healthcare of the most venerable. I have an issue that requires me to see a Pain Doctor every month no because of the draconian laws passed. For me it has cost me an extra 500 per year in Co-Pay (Monthly $45 and going to $55) plus I can’t get anything thing more than 30 days prescribed every month–so no reserve–no ability to have “Extra” all in the name of stopping illegal scrips. The office has Seasoned Citizens who need Ambulatory Care to go every month also, this is crazy–this has created a monopoly for these assemble line type Pain Clinics–I see the Dr. 1 time a year-the other 11 are a NP–they charge $175 to $285 to my insurance company for 15 minutes–It’s a real Rip Off–Mandatory Money–The Pain Clinics hit the lotto. Medicare/Medicaid is being ripped off legally and has started an industry of Seasoned Citizen Rip Offs for the sake of true need. This racket need to be looked into also–I think you will find the same thing I am experiencing across the Pain Industry.

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