Alive Hospice, Inc.
Outcome
Alive Hospice, Inc., a Tennessee non-profit hospice provider, paid over $1.5 million to resolve False Claims Act allegations of overbilling both Medicare and TennCare (Tennessee Medicaid) for hospice services.
Details
Alive Hospice, Inc. (Tennessee) — Medicare and TennCare Overbilling (2015)
Outcome: Alive Hospice, Inc., a Tennessee non-profit hospice provider, agreed to pay over $1.5 million to the United States and the State of Tennessee to resolve False Claims Act allegations of overbilling Medicare and TennCare (Tennessee Medicaid) for hospice services.
Alive Hospice operated as a non-profit hospice provider in Tennessee. The False Claims Act lawsuit alleged that the organization "alleged overbilling of Medicare and TennCare for hospice services" — submitting claims for services at levels, quantities, or rates that exceeded what was actually provided or was medically supported.
The case demonstrates that non-profit status does not confer immunity from federal healthcare fraud enforcement. The settlement was announced September 10, 2015 by the First Assistant United States Attorney for the Middle District of Tennessee, with Tennessee sharing in the recovery for TennCare overbilling. Hospice providers must submit claims only for services actually rendered, at the appropriate level of care (routine home care, continuous home care, inpatient care, or respite care), with documentation supporting every claim.
Primary Source: OIG Enforcement Record
How Crucible Prevents This
Crucible's hospice billing audit hooks would cross-reference claimed service codes against patient eligibility documentation, visit records, and physician certifications. Overbilling patterns — including inflated service levels, duplicate billing, or billing for non-covered services — are detectable through automated claim-to-documentation reconciliation.
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