Monday, May 27, 2024 May 27, 2024
80° F Dallas, TX
Advertisement
Healthcare

Dallas Home Health Company to Pay $4.7 Million to Settle False Claims Allegations

A whistleblower was fired immediately after expressing concerns about improper payments from Medicare for patients who didn't qualify for hospice care at Elara Caring.
|
Image

A whistleblower complaint resulted in Dallas-based Elara Caring paying $4.2 million to settle a False Claims Act allegation that the company submitted fraudulent claims and retained overpayments for hospice care.

The claims allege that Elara patients who were not eligible for hospice care still received the service while Elara billed Medicare for hospice, which reimburses at higher rates than home health or nursing home care.

The suit began with a whistleblower complaint from Aneko Jackson, a nurse and former Elara Caring employee. Jackson took a job with Elara as a regional clinical director in 2019, overseeing offices in Round Rock and New Braunfels, Texas. When looking for missing paperwork for a patient on hospice, court documents say Jackson discovered that nearly two dozen patients in the New Braunfels office lacked the required election statement to admit patients to hospice care. Despite the lack of paperwork, Jackson found that Elara had submitted claims to Medicare for hospice since the patients’ admission dates. 

When Jackson reported the issue, her supervisor told her that Elara would have the hospice chaplain and a social worker visit the patients to obtain the election paperwork and backdate it to when they began receiving hospice services. Jackson told her supervisor that this was illegal and Elara needed to report the overpayments, but her boss said she would sort the problem out, even though some of the patients with missing paperwork had already passed away.

Court documents say Elara did not report the improper payments to Medicare and that management rebuffed Jackson’s later attempts to bring up the issue. Immediately after a meeting where Jackson expressed her concerns about the lack of paperwork and improper payments to her colleagues, she was told her position “no longer existed,” and she was terminated. The False Claims Act states that Jackson will receive $672,000 for reporting the fraud. 

The federal complaint also alleges that the New Braunfels location of Elara frequently failed to discharge patients if they no longer required hospice care. Hospice is for terminal patients whose life expectancy is less than six months, and if the patient’s condition improves or stabilizes, they are no longer eligible. Jackson said she reviewed patient records and found that many patients had been receiving hospice payments for longer than six months and multiple years in at least one case. Other patients lacked the proper documentation to be moved to hospice care. 

A 2019 internal audit at Elara found that more than a dozen patients were improperly given hospice care, but court documents say Elara never reported the issue to Medicare. The Department of Justice release indicates that the problems were not limited to the New Braunfels location. The DOJ says the $4.2 million settlement resolves allegations connected to Elara’s Texarkana, Texas, location and two other patients throughout the state.

An Elara Caring spokesperson sent in a statement in response to the settlement. “Elara Caring entered into an agreement with the U.S. Department of Justice Civil Division to resolve a former employee’s allegations that certain hospice services provided by one of its CIMA Texas entities did not meet eligibility requirements for some patients. These services were primarily provided under prior ownership. No quality of care or patient care issues are involved in the allegations or settlement. The civil action will be dismissed. Since its formation in 2018, Elara has implemented compliance training, education, and risk monitoring policies across all of its operations. With the help of all its dedicated professional staff, caregivers and patients, Elara strives to fully comply with all regulatory standards.”

Elara Caring is the result of a 2018 merger between Great Lakes Caring, Jordan Health Services, and National Home Health Care. The company operates 200 locations in 17 states nationwide, employing 26,000 caregivers and serving 60,000 patients daily.

“The hospice benefit under Medicare provides critical services to vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will continue to ensure that this benefit is used to assist those who need it, and not to line the pockets of those who seek to abuse it.”

Author

Will Maddox

Will Maddox

View Profile
Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…
Advertisement