Dallas-based hospice care company Elara Caring and its subsidiaries were indicted by the federal government, which said the company knowingly submitted false claims and continued to collect overpayments from patients who were ineligible for hospice care. will be required to pay $4.2 million to resolve the claims.
The Justice Department's statement singled out the company's Texarkana location and said patients there had false claims submitted on their behalf and that many were not eligible for hospice care because they were not terminally ill.
Elara employs more than 30,000 people in 225 offices located in 16 different states. According to the company's website, it has approximately 60,000 patients.
Elara declined an interview request from Dallas Morning News. However, a company spokesperson said in an email that the company has compliance training, education and risk monitoring policies in place across all its businesses.
“Elara Caring is seeking assistance from the U.S. Department of Justice, Civil Division, to resolve claims by former employees that certain hospice services provided by one of CIMA’s Texas entities did not meet eligibility requirements for some patients. ,” the emailed statement said.
“These services were primarily provided under previous ownership. This complaint or settlement does not involve any quality of care or patient care issues. The civil action is dismissed.” said a company spokesperson. “At Elara, we work with all of our dedicated professional staff, caregivers, and patients to ensure full compliance with all regulatory standards.”
The lawsuit was filed by former employee Aneko Jackson under the whistleblower section of the False Claims Act. This allowed Mr. Jackson to sue on behalf of the United States. She will receive $672,000 as part of her settlement.
“We thank the Department of Health and Human Services for supporting this case and helping protect victims of fraud,” said Jamie Esparza, U.S. Attorney for the Western District of Texas. “These settlements hold criminals accountable and encourage those who suspect wrongdoing in the Medicare program to exercise their protected whistleblower rights.”
Mr. Jackson's attorney at Dallas-based Sumner Schick LLP declined an interview request, but said in a statement that he was “very satisfied with the outcome and that justice was served.”
Ms. Jackson has served as regional clinical director for Elara's Round Rock and New Braunfels facilities since June 2019. However, in February 2020, she noticed that one of her new patients was missing a statement regarding the election.
This forced the company to audit all new patient files, and according to the original complaint filed in April 2020, 20 patients admitted after December 4, 2019 signed election statements. It turns out that he did not.
After contacting regional administrator Sarah Hopper, Jackson told her that the company had been improperly billing patients for two months. However, Hopper and Elara allegedly ignored Jackson's warnings and instead insisted they would “figure everything out.”
Ms Jackson was told at a subsequent meeting that her job “no longer exists” and was fired shortly thereafter.
The New Braunfels facility had problems, particularly with admitting patients who did not qualify for hospice care, according to the complaint.
“Despite not having a medical license or proper qualifications, Mr. Hopper had the ultimate authority to decide whether to admit a patient to a hospice program and when the patient would be discharged,” the complaint states. “I was doing it,” it says. “Hopper had a reputation for keeping Elara's patients in hospice care even though they showed signs of improvement and stabilization.” They often complained to Mr. Hopper that their care did not meet the standards of hospice care.
At least one of Elara's patients had been in hospice care for multiple years, according to the lawsuit.
“Hospice care is intended to provide comfort and relief to terminally ill patients, and exploiting this system to make more money is unacceptable,” said Christian J., Deputy Inspector General of the Department of Health and Human Services Bureau of Investigation.・Schrank stated. of the Inspector General. “Working with our law enforcement partners, we will continue to pursue healthcare providers who jeopardize the integrity of hospice care by prioritizing unfair profits over medically necessary services.”
