The state and federal governments have intervened on a whistleblower suit against two local hospice providers and their parent company, alleging fraud and abuse of government-sponsored insurance benefits by maximizing their census through improper diagnosing and enrollment.
The lawsuit against Nashville-based Avalon Hospice, Brentwood-based Regency Health Care Group and Curo Health Services along with its parent company was originally filed in 2013 by multiple Avalon employees, including various clinicians, an office manager and a hospice care consultant. The offices of the U.S. Attorney and state Attorney General have been investigating the case since, electing to intervene in March after years of delays and filing their complaint earlier this week, in search for relief that could potentially reach tens of millions of dollars.
Plaintiffs of the suit allege Regency and Curo pressured Avalon staff to initiate false claims and conceal overpayments to maximize census and profitability. The lawsuit also accuses the consortium of companies of failing to provide accurate clinical information to physicians when determining their eligibility for hospice, and that Curo audited patient medical records to omit words that signaled a patient’s health was improving, which would make them no longer eligible for hospice care.
A spokesperson for the company denied the claims, telling WPLN News: “CURO does not believe that we violated the False Claims Act. 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.”
The whistleblowers of the suit claim they were fired from their jobs after expressing concern to company leadership about their admissions and clinical practices.
Lieff Cabraser’s Nashville office is representing one of the former Avalon employees who originally filed the suit.
Mark Chalos, a Lieff Cabraser attorney, told the Post that taxpayers are "cheated out of billions of dollars" each year through false claims by health care companies and other government contractors.
"Healthcare companies that rip off taxpayers must be held accountable," Chalos said. "The conduct alleged here is particularly egregious because it involved one of the most difficult and sacred periods of time: when a family ember is reaching the end of life.”
Avalon is owned by Brentwood-based Regency Healthcare Group, which is owned by North Carolina-based Curo Health Services, part of private equity firm Curo Holdings. Curo Health Services in 2018 was purchased by Humana and two private equity firms for $1.4 billion to combine with the home health division of Kindred Healthcare in what is now the largest hospice provider network in the nation.
The lawsuit pertains only to locations in Tennessee, but the companies' network spans hundreds of markets across the country.