The state of Tennessee and the Federal government on 1st June 2021 filed a combined case in intervention purporting that TNMO Healthcare, LLC(doing business as Avalon Hospice), Curo Health Services, LLC, Curo Health Services Holdings, Inc., and Regency Healthcare Group, LLC, breached the False Claims Statute and the Tennessee Medicaid False Claims Statute, reported Mary Jane Stewart, Acting U.S. Attorney for Tennessee’s Middle District and Herbert Slatery III, Tennessee Attorney General. Besides, the suit states common law allegations, such as reimbursement under a mistake of fact and unjustifiable enrichment.
As detailed in the case, from at least 2010, the accused breached the False Claims Statute and the Tennessee Medicaid False Claims Statute by deliberately submitting or triggering to be submitted fraudulent claims and deliberately and illegally covering up or evading Avalon’s requirement to reimburse over reimbursements, for hospice services offered to patients who were not eligible for the Medicaid or Medicare hospice benefit since they were not critically sick.
The complaint purports that the accused pressured their Tennessee hospice agencies workers to capitalize on admissions and census over aggressive financial incentives and targets, while at the same time discouraging the release of patients who were no more eligible for the Medicaid or Medicare hospice benefit. Besides, the indictment purports that the accused never ensured that doctors who offered lawfully required and material authorizations and reapprovals of patients’ terminal sicknesses received or sufficiently considered accurate and complete information concerning patients’ conditions. Also, the charge purports that even after the accused were made alert via internal audits and complaints that they had charged for hospice services offered to Medicaid or Medicare recipients who were hospice-ineligible, they never returned Medicaid or Medicare payments they had obtained.
The governments started investigating the accusations purported in the case in response to suits lodged under the False Claims Act’s and the Tennessee Medicaid False Claims Act’s qui tam or whistleblower provisions, which permits private Americans with knowledge of fraudulent claims to file civil suits on the government’s behalf and to share in any recovery.
The case was inquired by the HHS-OIG (Health & Human Services Department – Office of Inspector General) and the Tennessee Investigation Bureau – Medicaid Fraud Control Unit. U.S. Assistant Attorney Kaitlin E. Hazard and U.S. Assistant Attorney Wynn M. Shuford handled the matter’s prosecution on behalf of the Federal Government, and Assistant Attorney General Scott Corley handled the matter’s prosecution on behalf of Tennessee.
The claims purported by the federal government and the state of Tennessee are just allegations, and there has been no liability determination.
Violating the Controlled Substance Act, the Anti-Kickback Statute, and the False Claim Act is severely punished by the law. Besides, scheming to commit health care fraud like stealing taxpayer-funded health care programs, like the TRICARE, Medicare, or Medicaid programs, is a serious offense. Any individual who enacts these felonies violates the law and is severely fined or punished if found accountable for or pleads remorseful to the accusations. When indicted for these offenses, one must look for the best lawful help or representation to shield, fight, and trail their rights. If you seek the most remarkable legal help and representation, which assures favorable results for your case, you should choose our competent team of the greatest defense and criminal attorneys. Health Care Fraud Group consists of a highly experienced team of lawyers with incredible skills in handling Health Care Fraud-linked matters regarding Federal Health Care programs; they are highly well-versed in federal and civil affairs. The attorneys are well-known around the state due to their outstanding work and expertise when tackling healthcare fraud investigations and cases. Our skilled attorneys are well-versed in every aspect of healthcare fraud prevention, medical, and legal matters.
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