How This 8.5 Million Settlement Could Have Been Prevented

In June of 2018, Caris Healthcare agreed to pay $8.5 million to settle a false claims act lawsuit. The settlement resolved allegations that Caris Healthcare admitted and recertified patients for hospice care who were ineligible for the hospice benefit. The allegations against Caris originated from a registered nurse whistleblower who was a former employee.

What I find most interesting from the government’s press release, is it sounds as if the whole disastrous lawsuit could have possibly been prevented if the organization had noticed the whistleblower warning signs. And there are almost always signs.

In one study, The National Whistleblower Center, found that 89.7% of whistleblowers first reported their concerns internally to supervisors or compliance personnel before blowing the whistle. And this case was no different.

The government alleged that when Caris was alerted to the ineligibility of these patients—via internal audits, concerns raised by its Chief Medical Officer, and recommendations of its nurse employees who actually examined the patients—Caris not only continued to submit hospice claims to Medicare for the patients, but also took no meaningful action to determine whether it had previously received improper payments for these and other patients that should have been returned to Medicare.

Download my free eBrief, Common Activities that Lead to Whistleblowing (and How to Avoid Them), to learn how to see the signs that lead to whistleblowing, prevent whistleblowing as a result of retaliation, and create a compliance program that responds to concerns.