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Preet Bharara, the United States Attorney for the Southern District of New York, and Scott Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s (“HHS-OIG”) New York Region, announced today that the United States has settled civil fraud claims under the False Claims Act against COMPASSIONATE CARE HOSPICE OF NEW YORK, LLC (“CCH-NEW YORK”) and COMPASSIONATE CARE HOSPICE GROUP LTD. (“CCH GROUP” and collectively, “CCH”) related to CCH’s submission of fraudulent claims for reimbursement by Medicare and Medicaid, for hospice nursing services not adequately provided by CCH-NEW YORK.
In the settlement, approved today in Manhattan federal court by U.S. District Judge J. Paul Oetken, CCH-New York accepted responsibility for failing, at its Bronx location, to treat patients according to an individualized plan of care, failing to meet the needs of certain patients, failing to make nursing services available 24 hours a day and seven days a week as required, and failing to maintain adequate clinical records, while CCH Group accepted responsibility for failing to provide sufficient oversight of CCH-New York through its compliance audits. CCH-New York agreed to pay $4,992,000 to the United States and $1,680,000 to the State of New York to resolve its liability for this conduct. In addition, CCH entered into a corporate integrity agreement with HHS-OIG, through which it agrees to implement certain institutional compliance measures and submit to monitoring by HHS-OIG for five years.
Manhattan U.S. Attorney Preet Bharara said: “In addition to protecting public monies, this settlement agreement protects patients who require hospice care, by holding Compassionate Care Hospice accountable for providing inadequate services and sending a message to all similarly situated providers.”
HHS-OIG Special Agent in Charge Scott Lampert said: “CCH’s conduct compromised both the care provided to its patients as well as the integrity of the Medicare and Medicaid programs. This settlement affirms HHS-OIG’s commitment to holding providers accountable so that they provide high quality of care to their patients and bill health care programs appropriately.”
According to the complaint filed in Manhattan federal court:
Between May 2010 and September 2011, CCH-New York, at its Bronx location, failed to provide hospice nursing services in the manner required by the applicable regulations, including following patients’ plans of care, which typically required a hospice nurse to visit the patient one to three times per week. The complaint alleges that nurses employed by CCH-New York routinely missed these visits, then, at the direction of management in the Bronx office and with the knowledge of CCH Group, falsified nursing notes in patients’ files in order to make it appear as though the visits had been performed. CCH, nonetheless, billed Medicare and Medicaid for services not actually performed or not performed in compliance with the applicable regulations, and received millions of dollars as a result of the fraudulent claims.
Mr. Bharara thanked the Medicaid Fraud Control Unit of the New York State Attorney General’s Office for its assistance in the investigation.
The case is being handled by the Office’s Civil Frauds Unit. Assistant United States Attorney Cristy Irvin Phillips is in charge of the case.