A lawsuit filed against Caris Healthcare under the False Claims Act, alleging the company committed hospice care Medicare fraud, has been brought to an end with an $8.5 million settlement with the Department of Justice.

According to the whistleblower lawsuit, Caris Healthcare knowingly committed hospice care Medicare fraud by submitting false claims and by keeping the subsequent overpayments. Caris Healthcare reportedly submitted these claims for patients that were actually ineligible for Medicare hospice benefits.

The Department of Justice alleges  Caris had set admissions and census targets to reach for patients using Medicare, and to meet them would submit these false claims for patients who were not terminally ill.

Caris agreed to the $8.5 million settlement to resolve the hospice care Medicare fraud claims leveled against it by the government.

“Today’s settlement is an important reminder that compliance programs and activities cannot exist in name only. When a healthcare provider is put on notice that a patient is ineligible for a particular Medicare benefit or service, the healthcare provider cannot turn a blind eye to that information but, instead, must take reasonable steps to stop the improper conduct and to determine whether that conduct resulted in prior overpayments,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division, in a press release.

“When hospices increase their bottom lines by billing taxpayers for unneeded services, they are diverting money from vulnerable, terminally-ill individuals. Worse yet, these patients may not be receiving care for medical needs that would otherwise be covered in a non-hospice setting,” said Special Agent in Charge Derrick L. Jackson for the Office of Inspector General for the region including Tennessee.

The concern over Caris’s alleged involvement in hospice care Medicare fraud was first brought up by the Chief Medical Officer and nurse employees during an internal audit. It was then brought to the attention of the federal government by a whistleblower, a registered nurse and former employee of Caris Healthcare. The whistleblower receives a portion of the settlement reached—in this case, $1,402,500.

Filing a Whistleblower Lawsuit

Whistleblowers are individuals who report the fraud and illegal activities against the government of their current or former employers. Many employees choose to come forward as whistleblowers because they do not feel right about their employer’s actions. A whistleblower lawsuit can be filed while working at the company, but can also be filed after having left the company.

While a person considering becoming a whistleblower may be worried that they will face retaliation for their actions, the whistleblower is typically given a substantial reward—often between 15 and 30 percent of the money recovered in the subsequent whistleblower lawsuit. In this case, the nurse who acted as a whistleblower against Caris received more than $1 million for her part in bringing the hospice care Medicare fraud lawsuit.

If you believe you have witnessed some kind of fraud by your current or former employer, including hospice care Medicare fraud, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.