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Capital Caring hospice pays $3.1M federal settlement following Medicare billing investigation
Dominion Post - 9/11/2019
Sep. 10--MORGANTOWN -- Capital Caring, the Falls Church, Va.-based hospice organization formerly associated with Arthurdale-based WV Caring, has agreed to pay a $3.1 million civil settlement regarding allegations of Medicare overpayments for bills submitted to the Medicare Program for hospice services, according to a release from the U.S. Attorney's Office for the Eastern District of Virginia.
The overpayments occurred during
the period of 2010-15, when Malene Davis was president and CEO of Capital
Caring. During that period, Davis also carried the title of founding president
of WV Caring. She assumed the title of WV Caring president and CEO in 2016.
She stepped down from both
organizations in July 2018 but returned to WV Caring last March under the title
chief visionary officer and founding president.
According to the U.S.
Attorney's Office, "The overpayments were the result of claims Capital
Caring submitted to Medicare for hospice services for patients who the
government alleged either did not meet the hospice eligibility guidelines for
the Medicare Program, Title XVIII of the Social Security Act or for whom the
hospice clinical record information maintained by Capital Caring was
insufficient to support Medicare hospice coverage."
The investigation involved a coordinated effort by the
U.S. Attorney's Office, the FBI and the Department of Health and Human Services
Office of Inspector General.
The civil claims settled are allegations only, the U.S. Attorney's
Office said. There has been no determination of civil liability.
Capital Caring also announced the settlement in its own
"Capital Caring cooperated fully with the review of
certain hospice records for services furnished during that time period -- 4 to 9
years ago," it said. "This finalized resolution avoids protracted and expensive
litigation over disagreements related to hospice records and was resolved
without any allegations of fraudulent billing. Furthermore, this action
underscores Capital Caring's continued commitment to the families and communities
it serves in Virginia, the District of Columbia and Maryland."
Capital Caring Interim CEO Tom Koutsoumpas, who assumed
the position in August 2018, said, "We are happy to have concluded what was a
thorough review of hospice services provided a number of years ago. This
resolution allows us to keep focused, without distraction, on what Capital
Caring does best: providing the highest quality care for those individuals
coping with life-limiting illnesses."
Davis assumed her post at Capital Caring in 2006, taking over
the job from an interim CEO. Her Hospice Care/WV Caring titles changed several
times during the following years: executive director through 2009; founding
president from 2009 through 2015; and president and CEO in 2016.
WV Caring and Capital Caring had a joint operating agreement
finalized in 2016 and terminated in July 2018.
The Dominion Post reported in July 2018, following a months-long investigation, that Davis stepped down from both organizations following allegations she'd bullied employees and spent company money lavishly on herself and her leadership circle.
Koutsoumpas said at the time, "As many of you know, the Capital Caring Board of Trustees recently authorized a comprehensive operational review of the organization, conducted by an outside organization. The Capital Caring Board has a fiduciary responsibility to initiate tighter controls, operational improvements and enhanced oversight moving forward."
WV Caring's spokeswoman was not in her office on Tuesday. Contacted by cell phone, she said she had not seen an email with questions about the settlement and was unable to comment.
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