Gentiva Health Services, Inc. (successor to Kindred at Home / SouthernCare / SouthernCare New Beacon)
Outcome
Gentiva, as successor to Kindred at Home and affiliated entities, paid $19.428 million to resolve False Claims Act allegations that Avalon Hospice in Tennessee, Kindred hospice locations in Rhode Island, Texas, and Missouri, SouthernCare locations in Alabama and Indiana, and SouthernCare New Beacon in Alabama billed Medicare and Medicaid for hospice patients who were not terminally ill; a separate allegation covered an Alabama entity paying kickbacks to a consulting physician for referrals.
Details
Gentiva / Kindred at Home — Multi-State Hospice Billing for Ineligible Patients and Physician Kickbacks (2024)
Outcome: Gentiva Health Services, Inc., as successor to Kindred at Home and affiliated hospice entities, paid $19.428 million to resolve False Claims Act allegations that multiple hospice locations across seven states billed Medicare and Medicaid for patients who were not terminally ill and therefore did not qualify for the Medicare hospice benefit; a related allegation covered a kickback arrangement with a consulting physician.
The settlement, announced July 2024, consolidated nine separate qui tam whistleblower lawsuits and resolved allegations spanning from 2010 through February 2020 for the Tennessee conduct, and through 2022 for certain other locations.
The core allegation covered Avalon Hospice, operating in Tennessee under the Kindred at Home umbrella, which the United States and the State of Tennessee alleged knowingly submitted or caused the submission of false claims for hospice patients who were not terminally ill under Medicare's six-months-or-less eligibility standard. The Avalon/Tennessee conduct ran from 2010 to February 2020 and was the subject of a consolidated complaint originally filed in 2021.
Additional allegations covered Kindred hospice locations in Warwick, Rhode Island; Beaumont, Texas; and Independence, Missouri; SouthernCare New Beacon's location in Demopolis, Alabama; and SouthernCare locations in Daphne, Alabama; Mobile, Alabama; South Bend, Indiana; and Youngstown, Ohio. Each of these locations was alleged to have billed for patients who were not terminally ill. The Alabama segment also faced a separate allegation: between 2016 and 2022, SouthernCare New Beacon paid a consulting physician to induce referrals of Medicare beneficiaries, in violation of the Anti-Kickback Statute.
The federal government received $18,956,151, the State of Tennessee received $448,800, and the State of Ohio received $23,618. Nine separate qui tam relators — current and former Kindred employees — brought the underlying lawsuits. Kindred at Home was one of the largest for-profit home health and hospice companies in the United States before being rebranded as Gentiva following a corporate restructuring.
How Crucible Prevents This
Crucible terminal prognosis documentation controls would require physician recertification attestations to be supported by clinical documentation of patient decline at each 60- or 90-day recertification interval. An automated eligibility flagging module would identify patients who have been on hospice service for more than 180 days without documented decline trajectory, triggering mandatory clinical review before the next certification. Consulting physician compensation monitoring would flag arrangements where a physician receives remuneration from a hospice entity and also provides referrals, requiring independent legal review. Crucible's whistleblower intake and protection module would support the nine qui tam relators who disclosed this conduct.
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