The United States and State of Tennessee have filed a consolidated complaint in intervention alleging violations of the False Claims Act and the Tennessee Medicaid False Claims Act by four healthcare companies, including Brentwood-based Regency Healthcare Group.
According to a news release by the United States Attorney's Office for the Middle District of Tennessee, in addition to Regency Healthcare Group, the complaint also named Curo Health Services Holdings, Inc., Curo Health Services, LLC, and TNMO Healthcare, LLC (d/b/a Avalon Hospice).
The complaint also alleges common law claims, including unjust enrichment and payment under mistake of fact.
According to that release, prosecutors allege that since at least 2010, the four defendants violated the False Claims Act and the Tennessee Medicaid False Claims Act by "knowingly submitting or causing to be submitted false claims, and knowingly and improperly concealing or avoiding Avalon’s obligation to repay overpayments, for hospice services provided to patients who were ineligible for the Medicare or Medicaid hospice benefit because they were not terminally ill."
The complaint alleges that the defendants pressured staff at the hospice agencies to maximize their admissions and census goals through "aggressive financial targets and incentives."
In addition, prosecutors allege that at the same time the defendants discouraged these staff members from discharging patients who were no longer eligible for the Medicare or Medicaid hospice benefit.
The complaint also alleges that the defendants were made aware of inconsistencies found through both audits and internal complaints that showed that they had billed for hospice services that were provided to Medicare or Medicaid beneficiaries who were not hospice-eligible, but did not return the payments that they had received.
Prosecutors also allege that the defendants "failed to ensure that physicians who provided legally required and material certifications and recertifications of patients’ terminal illnesses received or adequately considered complete and accurate information regarding patients’ conditions."
According to the news release, the government's investigation was sparked by a whistleblower complaint and the complaint was investigated by the Department of Health and Human Services, Office of Inspector General and the Tennessee Bureau of Investigation Medicaid Fraud Control Unit.