Eli's Hospice Insider

Published on Tue Jul 13, 2021 PDF

CURO Health Services Holdings Inc., CURO Health Services, TNMO Healthcare (d/b/a Avalon Hospice), and Regency Healthcare Group are facing a joint state-federal lawsuit accusing Avalon Hospice of providing hospice care to ineligible patients, among other misdeeds.

“The defendants pressured staff at their Tennessee hospice agencies to maximize admissions and census through aggressive financial targets and incentives, while simultaneously discouraging the discharge of patients who were no longer eligible for the Medicare or Medicaid hospice benefit,” the Department of Justice says in a release. “Moreover … the defendants failed to ensure that physicians who provided legally required and material certifications and recertifications of patients’ terminal illnesses received or adequately considered complete and accurate information regarding patients’ conditions.”

Plus: “Even after the defendants were made aware through internal complaints and audits that they had billed for hospice services provided to Medicare or Medicaid beneficiaries who were not hospice-eligible, they did not return Medicare or Medicaid payments they had received,” the DOJ charges.

The whistleblower-sparked lawsuit cites one hospice patient that was on service for six years, notes WPLN News. It also accuses Avalon, the state’s largest hospice, of working closely with Tennessee nursing homes to enroll their residents, pitching their services as a way to lighten the load for nursing home staff, according to the National Public Radio station.

The suit has finally been made public “after eight years of delays,” claims Mark Chalos, the Lieff Cabraser attorney representing one of the qui tam relators, in a release.

“CURO does not believe that we violated the False Claims Act,” the Avalon parent company says in a release provided to multiple news outlets. “We go to great lengths to ensure that our patients meet the Medicare requirements for eligibility — which includes the physician’s certification of terminal illness.”

CURO is based in North Carolina and owned by health insurer Humana along with private equity investors, according to WPLN News.