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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.
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.