Category: MIL-OSI

Source: United States Department of Justice Criminal Division

Gentiva, successor to Kindred at Home, has agreed to pay $19.428 million to resolve allegations that Kindred at Home and related entities (Kindred) knowingly submitted false claims and knowingly retained overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programs. Gentiva’s hospice operations, headquartered in Atlanta, include entities that previously operated Kindred at Home hospice locations under the names Avalon, Kindred, SouthernCare and SouthernCare New Beacon.

“The hospice benefit under Medicare and other federal health care programs provides critical services to some of the most vulnerable patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will ensure that this important benefit is used to assist those who need it, and not as an opportunity to line the pockets of those who seek to abuse it.”

The settlement resolves allegations made by the United States and the State of Tennessee in a consolidated complaint filed in 2021 against certain Kindred related entities alleging that, from 2010 until February 2020, the defendants knowingly submitted or caused to be submitted false claims for hospice services provided to Avalon hospice patients in Tennessee who were ineligible for the Medicare or Medicaid hospice benefit because they were not terminally ill. The settlement also resolves the complaint’s allegations that the defendants improperly concealed or avoided Avalon’s obligation to repay those hospice claims.

In addition, the settlement resolves allegations that certain Kindred, SouthernCare and SouthernCare New Beacon hospice locations knowingly submitted, or caused to be submitted, false claims for hospice services provided to patients who were ineligible for hospice benefits under Medicare and other federal health care programs because the patients were not terminally ill. Those hospice locations were Kindred’s locations in Warwick, Rhode Island; Beaumont, Texas; and Independence, Missouri; SouthernCare New Beacon’s location in Demopolis, Alabama; and SouthernCare’s locations in Daphne, Alabama; Mobile, Alabama; South Bend, Indiana; and Youngstown, Ohio. The settlement also resolves allegations that those Kindred, SouthernCare and SouthernCare New Beacon locations knowingly and improperly concealed or avoided obligations to repay the foregoing hospice claims.

Further, the settlement resolves allegations that SouthernCare New Beacon allegedly violated the Anti-Kickback Statute by willfully paying renumeration to a consulting physician, between Oct. 1, 2016, and Oct. 1, 2022, to induce hospice referrals of Medicare beneficiaries to its Gadsden, Alabama, location. The settlement of those allegations stems from a voluntary self-disclosure made by New Beacon Healthcare Group LLC doing business as SouthernCare New Beacon Hospice. The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded health care programs. It is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives and are instead based on the best interests of their patients.

“Hospice provides vital care and support for terminally ill patients and their families. Medicare’s and TennCare’s eligibility requirements ensure that federal and state health care money is properly used to support hospice programs,” said U.S. Attorney Henry C. Leventis for the Middle District of Tennessee. “We are committed to holding accountable health care companies and providers who prioritize profits over patient care by ignoring these requirements.”

“This office remains committed to safeguarding public monies,” said U.S. Attorney Michael A. Bennett for the Western District of Kentucky. “I commend the work of all those in the department who have made this successful settlement possible and truly appreciate the strong working relationships that exist between the United States Attorneys’ Offices, the Civil Division’s Fraud Section and our law enforcement partners.”  

“My office remains determined to ensure that federal funding for essential health care, like the hospice care at issue in this investigation, goes to the patients who need it, rather than to health care companies who seek to exploit those patients for profit,” said U.S. Attorney Zachary A. Cunha for the District of Rhode Island. “Today’s result reflects a concerted effort by this office and U.S. Attorneys’ Offices around the country, working alongside the Fraud Section of the Justice Department’s Civil Division, and our law enforcement partners, to help to guarantee that Medicare funds are directed where they belong and that high-quality hospice care is available for patients and their families in the future.”

“Hospice care is special end-of-life care intended to provide comfort for terminally ill patients. The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis, not a hospice provider’s desire to increase profits,” said U.S. Attorney Todd Gee for the Southern District of Mississippi. “The continued work of the department and our law enforcement partners is critical to the integrity of these important programs. I appreciate the work of all involved in this significant case.”

“Our office is committed to protecting federal healthcare programs like the Medicare hospice benefit from false claims” said U.S. Attorney Sean Costello for the Southern District of Alabama. “We will hold accountable any providers that abuse taxpayer dollars.”

“The integrity of hospice care is critical to the millions of patients receiving these services,” said Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “We, along with our law enforcement partners, will continue to ensure that providers who focus on personal financial gain rather than providing medically necessary, high-quality hospice care will be held accountable.”

The Medicaid program is funded jointly by the state and federal governments. As a result of the settlement announced today, the federal government will receive $18,956,151.32, the State of Tennessee will receive $448,800 and the State of Ohio will receive $23,618.68.

The settlement includes the resolution of claims in nine lawsuits brought under the qui tam or whistleblower provisions of the False Claims Act by various current and former Kindred employees. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam cases are captioned: United States ex rel. Pence, et al. v. Curo Health Services Holdings, Inc., et al., Civil Action No. 3:13-00672 (M.D. Tenn.); United States,, et al. ex rel. Anderson et al. v. Curo Health Services, LLC d/b/a Avalon Hospice, Civil Action No. 3:20-cv-00168 (M.D. Tenn.); United States ex rel. Riar v. Kindred Healthcare, Inc., et al., Civil Action No. 3:18-CV-52 (W.D. Ky.); United States ex rel. Didde, et al. v. Kindred Healthcare Inc. et al., Civil Action No. 19-2321-JWB-JPO (D. Kan.); United States ex rel. Mut v. Gentiva Certified Healthcare Corp. D/B/A Kindred at Home, Civil Action No. 1:21-cv-00425-JJM-PAS (D.R.I.); United States ex rel. Harris v. SouthernCare, Inc., Civil Action No. 3:18-cv-643-HTW-LGI (S.D. Miss.); United States,, et al. ex rel. Roy v. Curo Health Services, LLC, et al., Civil Action No. 3:18-cv-643-HTA-LRA (S.D. Miss.); U.S. ex rel. Petrey v. Curo HealthCare Services, LLC, et al., Civil Action No. 1:19-CV-00617 (S.D. Ala.), and United States ex rel. Medved, et al. v. SouthernCare, Inc. D/B/A SouthernCare, et al., Civil Action No. 2:23-cv-3345 (S.D. Ohio). The share of the settlement to be received by the whistleblowers has not yet been determined.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorneys’ Offices for the Middle District of Tennessee, Western District of Kentucky, District of Kansas, District of Rhode Island, Southern District of Mississippi, Southern District of Alabama and Southern District of Ohio, with assistance from HHS-OIG, the Defense Criminal Investigative Service, the Office of Personnel Management Office of Inspector General, the Department of Veterans Affairs Office of Inspector General, the Office of the Tennessee Attorney General and the Office of the Ohio Attorney General.

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).

Trial Attorney William E. Olson of the Civil Division’s Commercial Litigation Branch, Fraud Section and Assistant U.S. Attorneys Wynn M. Shuford for the Middle District of Tennessee, Jessica R.C. Malloy and William F. Campbell for the Western District of Kentucky, Jon P. Fleenor for the District of Kansas, Kevin Love Hubbard for the District of Rhode Island, Deidre Lamppin Colson for the Southern District of Mississippi, Nina T. Herring for the Southern District of Alabama and W. Hunter West and Michael J. T. Downey for the Southern District of Ohio handled the matter.

The claims resolved by the settlement are allegations only. There has been no determination of liability.

Source: United States Department of Justice Criminal Division

Hemisphere GNSS (USA) Inc., a satellite global positioning system manufacturer in Arizona that was purchased by CNH Industrial in 2023, has agreed to pay $2.6 million to settle allegations that it violated the False Claims Act by knowingly providing false information to apply for and receive forgiveness of a Paycheck Protection Program (PPP) loan to which the company was not entitled.

Congress created the PPP in March 2020, as part of the Coronavirus Aid, Relief and Economic Security (CARES) Act, to provide emergency financial support to millions of Americans suffering the economic effects caused by the pandemic. The CARES Act authorized billions of dollars in forgivable loans to small businesses struggling to pay employees and other expenses. In 2021, Congress offered a second round of forgivable PPP loans through the Economic Aid to Hard-Hit Small Businesses, Nonprofits and Venues Act. When applying for PPP loans, borrowers were required to certify the truthfulness and accuracy of all information provided in their loan applications.

In February 2021, Hemisphere applied for a second round PPP loan and certified that it was eligible to receive the loan. Among other certifications, Hemisphere represented that no “entity created in or organized under the laws of the People’s Republic of China” owned or held 20% or more of an economic interest in Hemisphere. The company also certified that it did not retain as a board member a person who is a resident of the People’s Republic of China. At the time of its application, however, both of these certifications were allegedly false. For this reason, Hemisphere was not eligible for the second round PPP loan it received. After receiving this PPP loan, Hemisphere sought and received forgiveness of the total loan amount.

“PPP loans were an important but finite resource available to help eligible small businesses retain employees and keep their doors open,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “When ineligible entities improperly sought PPP loans or forgiveness of those loans, they reduced the availability of this critical support for eligible businesses.”

“Legitimate PPP loans saved small businesses across America,” said U.S. Attorney Gary M. Restaino for the District of Arizona. “But not everyone used the program as intended. Our office will continue to hold accountable those business and individuals who misused the PPP program, as the settlement announced today reflects.”

“The settlement in this matter demonstrates the excellent results achieved through the combined efforts of SBA and the Department of Justice to uncover and forcefully respond to PPP misconduct,” said General Counsel Therese Meers of the Small Business Administration (SBA). “The federal government is strongly committed to identifying and aggressively pursuing any instances of fraud or misconduct within the Paycheck Protection Program.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by GNGH2 Inc. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. GNGH2, Inc. v. Hemisphere GNSS (USA) Incorporated, 2:22-cv-00224 (D. Arizona). GNGH2 will receive $260,000 as its share of the settlement.

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the District of Arizona, with assistance from SBA’s Office of General Counsel and Office of the Inspector General.

Trial Attorney John F. Schifalacqua of the Justice Department’s Civil Division and Assistant U.S. Attorney Anne E. Nelson for the District of Arizona handled the matter.

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Justice Department in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The task force bolsters efforts to investigate and prosecute the most culpable domestic and international actors committing civil and criminal fraud and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts. For more information on the department’s response to the pandemic, please visit www.justice.gov/coronavirus.

Tips and complaints from all sources about potential fraud affecting COVID-19 government relief programs can be reported by visiting the webpage of the Civil Division’s Fraud Section, which can be found here. Anyone with information about allegations of attempted fraud involving COVID-19 can also report it by calling the Justice Department’s National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.

The claims resolved by the settlement are allegations only. There has been no determination of liability.

Source: United States Department of Justice Criminal Division

OVW conducted a live web-based pre-application information session for its Fiscal Year 2024 Special Tribal Criminal Jurisdiction: Targeted Support for Alaska Native Tribes Special Initiative (STCJ AK) Program solicitation. During the presentation, OVW staff reviewed this program’s requirements, discussed the solicitation, and allowed for a brief question-and-answer period.

Source: United States Department of Justice Criminal Division

The Justice Department, in close coordination with the Department of Education, announced today the continued and growing success of a process instituted in November 2022 for handling cases in which individuals seek to discharge their federal student loans in bankruptcy. Data and information tracking the effectiveness of the process over the last year and a half demonstrate that it is achieving its goal of providing a more transparent, equitable, and streamlined mechanism for borrowers to request a discharge of their student loans in consumer bankruptcy cases. The process has translated into increasing numbers of eligible federal student loan borrowers seeking and obtaining debt relief under the Bankruptcy Code.  

The Departments finalized new guidance in November 2022 that outlined a fairer, more accessible process to ensure consistent treatment of the discharge of federal student loans, reduce the burden on borrowers of pursuing such proceedings, and facilitate identifying cases where discharge is appropriate. At the time, both Departments committed to an ongoing assessment of the guidance’s effectiveness. As part of that commitment, the Justice Department surveyed all 94 U.S. Attorneys’ Offices after the first year of implementation, and it recently repeated its survey to obtain updated information about use of the guidance.

The information that the Departments have collected from these surveys indicates that the new process continues to be a success, and that an increasing number of borrowers are seeking and receiving discharges of their federal student loan debts. In particular, since the process was announced a year and a half ago, the data collected by the departments reveals that:   

• As anticipated, case filings have steadily increased as consumers have learned of the new process. A total of 588 new cases were filed from October 2023 to March alone, which is a 36% increase from the prior six-month period. And a total of 1,220 cases were filed from November 2022 through March, a significant increase from recent years. The departments expect this trend to continue.
• The vast majority of borrowers seeking discharge continue to benefit from the guidance. In cases decided by the courts from November 2022 through March, 98% have provided debt relief through full or partial discharge. And the overall number of court judgments providing full or partial discharge have continued to increase, with the number of such judgments over the last six months exceeding the number of judgments for the preceding 12 months.
• Borrowers continue to embrace the new process set forth in the guidance in large numbers. In filed cases, 96% of all borrowers are voluntarily using the streamlined process, which includes a standard attestation form that allows borrowers more easily to identify and provide relevant information in support of their discharge request.
• Multiple bankruptcy courts have adopted procedures recognizing the utility of the new process, aimed at further streamlining the procedures debtors must follow to obtain discharges.

“We are now able to evaluate the success of the student loan bankruptcy discharge guidance with a robust record of empirical information,” said Acting Associate Attorney General Benjamin C. Mizer. “The results are clear: this guidance has helped make the promise of a fresh start in bankruptcy a meaningful option for individuals weighed down by student loan debt.”

“Our clear, fair, and practical standards are helping struggling borrowers find relief that was previously out of reach,” said U.S. Under Secretary of Education James Kvaal. “This data should puncture the myth that struggling borrowers cannot discharge their student loan debt through bankruptcy. We will continue to work with our partners at the Department of Justice to make it simpler and easier for borrowers to get much-needed relief in the way it was intended.”

In addition to the internal data surveys, the Justice Department has taken other measures to support and evaluate the new guidance. The Justice Department has been consulting closely with the Department of Education on the process. Since the implementation of the guidance, a dedicated group of experts within the Justice Department’s Civil Division also has collected input on the new process from consumer law groups, including the National Association of Consumer Bankruptcy Attorneys. Finally, the Civil Division has conducted trainings for Justice Department attorneys as well as members of the public, including training events supported by regional bar associations and the courts. The Department of Education also participated in training events hosted by regional bar associations, the American Bankruptcy Institute and U.S. Trustee Program, as well as at the annual meeting of the National Association of Chapter 13 Trustees, which included private attorneys as well as Chapter 13 trustees.

The Departments will continue to monitor the impact of the guidance to ensure that it is appropriately implemented and meets the goals it was designed to achieve.