The United States and Tennessee filed a consolidated complaint in intervention alleging violations of the False Claims Act and the Tennessee Medicaid False Claims Act by Curo Health Services Holdings, Inc., Curo Health Services, LLC, TNMO Healthcare, LLC (d/b/a Avalon Hospice), and Regency Healthcare Group, LLC. The complaint also states common law claims, including unjust enrichment and payment under mistake of fact. As set forth in detail in the complaint, since at least 2010, the 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 their Tennessee hospice agencies to maximize admissions and census through aggressive financial targets and incentives, while simultaneously discouraging the discharge of patients who were no longer eligible for the Medicare or Medicaid hospice benefit. Moreover, the complaint alleges 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. Furthermore, the complaint alleges that 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.
