Local whistleblowers help in federal hospice investigation
BOARDMAN, Ohio (WKBN) — The parent company that operates a hospice provider in Boardman has agreed to a settlement in a federal lawsuit alleging that the local location, along with others in the southern part of the country, defrauded the government, according to federal prosecutors.
Gentiva, formerly known as Kindred at Home, has agreed to pay $19 million to resolve allegations that it and other entities of Gentiva knowingly submitted, or caused to be submitted, false claims for hospice services provided to patients who were ineligible for hospice benefits under Medicare and other federal health care programs because the patients were not terminally ill, according to Department of Justice.
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The Employment Law Group said in a news release that there were 20 whistleblowers in the case, including two from the Youngstown area involving SouthernCare, who helped to recover about $2.13 million in alleged fraudulent billing.
“They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery,” said Janel Quinn, a principal of The Employment Law Group.
[ADDITIONAL COVERAGE]
Gentiva Settles FCA Claims Against Kindred at Home
From Hospice News (July 18, 2024)
Gentiva has agreed to pay $19.4 million to resolve False Claims Act complaints that predate the company’s acquisition of Kindred at Home.
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Gentiva’s parent company, the private equity firm Clayton, Dublier and Rice, acquired a 60% stake Kindred at Home’s hospice assets in 2022 for $2.8 million, with previous owner Humana Inc. (NYSE: HUM) retaining the remaining 40%.
“The hospice benefit under Medicare and other federal health care programs provides critical services to some of the most vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in a statement. “The department will ensure that this important benefit is used to assist those who need it, and not as an opportunity to line the pockets of those who seek to abuse it.”
>> View full story on Hospice News
Kindred to Pay $19.43 Million in Hospice Services Settlement
From Bloomberg Law (July 17, 2024)
The Justice Department reached a settlement with Gentiva Health Services, successor to Kindred at Home, for $19.43 million to resolve allegations that the company knowingly submitted false claims and retained overpayments for hospice services provided to patients who were ineligible for Medicare or Medicaid hospice benefits, the department announced Wednesday.
The settlement also resolves allegations that SouthernCare New Beacon, a Gentiva affiliate, violated the Anti-Kickback Statute by willfully paying renumeration to a consulting physician, between 2016 and 2022, to induce hospice referrals of Medicare beneficiaries to its Gadsden, Ala., location, the department said.
>> View full story on Bloomberg Law
Kindred hospice agrees to pay $19M in multi-state DOJ false claims case
From Compliance Week (July 18, 2024)
A multi-state hospice home health provider agreed to pay $19.4 million to settle allegations that it paid kickbacks and knowingly billed federal health programs to treat non-terminally ill patients.
Kindred at Home, now Gentiva, allegedly filed false claims to Medicare and/or Medicaid at its operations in Alabama, Indiana, Ohio, Rhode Island, Missouri, and Texas, the Department of Justice (DOJ) and state of Tennessee alleged in a settlement agreement, filed in U.S. District Court for the Middle District of Tennessee.
>> View full story on Compliance Week
Hospice provider with Warwick location settles false claims lawsuit for $19.4M
From Providence Business News (July 18, 2024)
PROVIDENCE — Gentiva, a national hospice provider with a facility in Warwick, has agreed to pay $19.4 million to resolve allegations it knowingly submitted false claims and retained overpayments for services provided to patients who were ineligible to receive hospice benefits.
WKBN
Hospice Provider Will Pay $19.4 Million to Settle Claims It Charged Government Programs for Ineligible Patients
Two Ohio Nurses Share a Reward for Blowing the Whistle on Medicare Fraud
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WASHINGTON, D.C. (July 19, 2024) — A national network of hospice providers agreed to pay more than $19.4 million to resolve claims that some of its facilities charged government insurance programs for providing services to patients who didn’t qualify for hospice coverage, the U.S. Department of Justice announced on July 17.
Federal prosecutors said they had reached the settlement with Gentiva, formerly known as Kindred at Home, after digging into wide-ranging allegations from more than 20 whistleblowers over a decade — including two Ohio hospice nurses represented by The Employment Law Group® law firm.
The nurses, Jason Medved and Anthony Donnadio, will receive a portion of the payout as their reward for alerting the government to alleged fraud at a Youngstown hospice via a lawsuit they filed in 2023 under the federal False Claims Act (FCA).
The FCA, signed into law by President Abraham Lincoln in 1863, makes it illegal to claim payment from the federal government via deception. The law includes a “qui tam” provision that allows whistleblowers to file a complaint on behalf of the U.S. and — if they prevail — to receive a portion of any resulting settlement or judgment.
In order to be reimbursed by taxpayer-funded programs such as Medicare, hospice facilities must claim payment only for patients whom a doctor expects to die within six months. But according to Mr. Medved, Mr. Donnadio, and the other whistleblowers, Kindred/Gentiva facilities pressured staff to admit patients who were “plainly ineligible” for hospice care — and who sometimes didn’t seem sick at all.
In their newly unsealed complaint, for instance, Mr. Medved and Mr. Donnadio listed multiple cases where patients were diagnosed with conditions such as late-stage Alzheimer’s disease, cirrhosis of the liver, or chronic obstructive pulmonary disease, all without having symptoms or laboratory results consistent with such diagnoses.
In one example in the complaint, a patient was admitted for chronic kidney disease. When Mr. Donnadio observed that the patient showed no signs of such kidney trouble, a doctor switched the diagnosis to late-stage Alzheimer’s disease — for which the patient also showed no symptoms, according to the complaint.
Besides defrauding the government, inappropriate hospice care can harm patients because it doesn’t include any treatment that’s intended to cure underlying conditions. According to the nurses’ FCA complaint, several patients left the Youngstown hospice after learning they weren’t fatally ill.
Gentiva denied the allegations but agreed to settle nine separate lawsuits, paying almost $19 million to the U.S. government, almost $450,000 to the state of Tennessee, and more than $23,600 to the state of Ohio. In all, the settled allegations spanned seven states and included both fraud and kickbacks.
About $2.13 million of total recovery was attributed to the Ohio claims pressed by Mr. Medved and Mr. Donnadio, both of whom resigned from the Youngstown facility, which operates under Gentiva’s SouthernCare Hospice Services brand.
“As registered nurses, Jason and Anthony owed a duty to their hospice patients first and foremost,” said Janel Quinn, a principal of The Employment Law Group. “They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery.”
Ms. Quinn represented Mr. Medved and Mr. Donnadio, along with TELG associate attorney Lydia A. Pappas and the firm’s managing principal, R. Scott Oswald. They worked on the case with Ann Lugbill and Nicolas Mendoza of Murphy Anderson PLLC, and in close cooperation with William E. Olson, a trial attorney at the Justice Department, and Assistant U.S. Attorneys W. Hunter West and Michael J.T. Downey at the U.S. Attorney’s Office for the Southern District of Ohio.
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Case Information
United States ex rel. Medved v. SouthernCare, Inc.
No. 2:23-cv-3345
U.S. District Court for the Southern District of Ohio
Complaint filed on October 10, 2023 (available here)
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About The Employment Law Group
The Employment Law Group® law firm represents whistleblowers and employees who stand up to wrongdoing in the workplace. Based in Washington, D.C., the firm takes cases nationwide.
Sreya Mahara
Sreya Mahara is a project assistant at The Employment Law Group® law firm. She earned her Bachelor of Arts in international relations from the University of Virginia in 2021. During her time at UVA, Ms. Mahara interned with the international development firm BlueLaw International.
She also gained experience working as a program assistant for the Bureau of Humanitarian Assistance at the U.S. Agency for International Development. After relocating from Charlottesville to the DMV area, Ms. Mahara aims to pursue graduate studies. Outside of work, she enjoys reading, dancing, and spending time with her five-year-old rescue dog, Makaveli.
Charity Dera
Charity Dera is a part time student at Stetson University College of Law. She expects to graduate in May of 2026 and is pursuing a concentration in social justice advocacy. Ms. Dera is also an alumna of the University of South Florida, where she obtained her bachelor’s in mass communications.
Prior to becoming a law clerk at The Employment Law Group® law firm, Ms. Dera worked at a variety of nonprofit organizations in the Tampa Bay area for approximately six years. It is within the social services context that Ms. Dera learned advocacy through the lens of case management. She aspires to be a public servant by continuing to demonstrate sacrificial commitment to the vulnerable and underserved.
Outside of work, Ms. Dera enjoys spending quality time with her husband, children, and church family.
Chris Johnston
Chris Johnston is currently pursuing his law degree in the evening program at the University of Baltimore School of Law, with an anticipated graduation date in May 2027. His professional background includes significant experience in law enforcement and casino compliance regulations at various levels of government — local, state, and federal.
Originally from Richmond, Virginia, Mr. Johnston completed his undergraduate studies at West Virginia University, where he earned a Bachelor of Arts degree in criminology.
Senate Gets Chance To Tackle An Overlooked Form of Bias
Law360 (May 20, 2024, 5:01 PM EDT) — A bill invalidating mandatory arbitration agreements for workplace age discrimination claims recently won bipartisan support for a full Senate vote, a development experts say gives lawmakers a chance to curb a type of bias that’s remained stubbornly persistent as some people perceive it as acceptable.
The Protecting Older Americans Act, which was introduced in June 2023 by Sen. Kirsten Gillibrand, D-N.Y., and co-sponsored by Sen. Lindsey Graham, R-S.C., passed out of the Senate Judiciary Committee on May 9. The legislation, which cleared committee by a 15-6 vote, would amend the Federal Arbitration Act to invalidate pre-dispute mandatory arbitration agreements — which many employees sign as part of their onboarding paperwork — and allow workers over 40 with age discrimination claims the option of bringing them in court instead.
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Anita Mazumdar Chambers of The Employment Law Group, who represents employees, said age discrimination frequently takes the form of a gradual erosion of duties, or a shifting of the best projects from older to younger workers.
Or an employer might say it needs to shed some of its “more expensive” workers, which can be code for tenured or older employees, Chambers said.
She said she wouldn’t go as far as to say age bias is “acceptable,” but said that “people might not be as aware that certain comments or ideas are in fact ageist — like looking for a fresher perspective or new blood on a project.”
