Kindred Healthcare Inc. affiliate Gentiva allegedly billed Medicare for hospice services unnecessarily, according to a whistleblower lawsuit unsealed on Monday.
The complaint was filed by Gentiva Area Vice President Alan Stewart in 2014 against Gentiva, claiming the provider kicked off a “new financial plan” in 2013 that led to home health patients being recoded as Medicare hospice beneficiaries. These transitions often happened without patients’ physicians’ knowledge, and “little to no effort to comply with Medicare conditions of payment or participation,” court documents read.
More than half of the patients transitioned from home health to hospice were not terminally ill, and therefore not eligible for the Medicare hospice benefit. Medical records showed 56% of the patients transferred had a “good or fair prognosis,” with the majority of those patients having “good or fair rehabilitation potential,” according to court documents.
When Stewart took his concerns over the billing to Gentiva officials “his claims were dismissed and his job threatened.” One official told Stewart hospice “is the most profitable line of business that Gentiva has and that home health is the pool of patients that we draw from.”
The Department of Justice declined to intervene in the case, leading to its being unsealed by the U.S. District Court for the Middle District of Alabama. An attorney for Stewart told Bloomberg BNA that Stewart has not chosen whether or not he’ll proceed with the case without intervention from the government.
In a statement to McKnight’s, Kindred said it and Gentiva are “dedicated to quality home health and hospice care for our patients and are committed to compliance with all laws, rules and regulations.”
“We don’t comment on pending litigation but we dispute the allegations in this lawsuit and will defend these and any related claims vigorously,” the statement reads.
Gentiva prevailed last year in a similar case, with a U.S. District Court judge finding the whistleblower failed to deliver sufficient evidence to link specific records to the alleged false billing.
