Gentiva: The Patients and Payments Behind the Changing Names

The Gentiva hospice settlement required $19,428,570 to resolve allegations of billing for ineligible hospice patients, keeping overpayments and paying for referrals. Behind the changing company names were decisions a hospice employee would recognize: who stayed on service, what the certifying physician was told, and what happened when an internal review questioned the payments.

The Department of Justice announced the resolution on July 17, 2024, identifying Gentiva as the successor to Kindred at Home. The hospice fraud allegations involved operations using the Avalon, Kindred, SouthernCare and SouthernCare New Beacon names. Taxpayers allegedly funded hospice health care for patients who did not qualify for the benefit.

Curo joined the Kindred at Home business in July 2018. Some of those businesses became part of Gentiva in August 2022. The agreement follows those businesses back to specific branches and periods of care.

Avalon Hospice and the Information Behind the Certification

At Avalon’s Nashville and Chattanooga operations, the government alleged both claims for ineligible patients and the retention of payments for that care. The eligibility allegations reached the information doctors received before they certified patients as terminally ill.

In its account of the Tennessee complaint, the Justice Department alleged that the companies failed to ensure certifying physicians received or adequately considered complete and accurate information about patients’ conditions. The allegations included pressure over admissions and census, discouraged discharges, and internal warnings about patients who did not qualify.

A physician’s signature sits at the end of that process. The nurse who assessed the patient may know what the chart said before it reached the doctor. A clinical manager may know why a discharge recommendation went nowhere. Those are decisions inside the business, with a direct connection to the claim for payment.

The repayment allegation concerns what happened after the problem surfaced. The government alleged that internal complaints and audits alerted the companies to payments for ineligible patients, yet they kept the Medicare and Medicaid money. That gives an insider in billing or compliance a different view of the same case: the warning, the response and the payment left unreturned.

Which Branches Did the Gentiva Settlement Cover?

The settlement covered named hospice operations in Tennessee, Rhode Island, Texas, Missouri, Alabama, Indiana and Ohio. Each branch had its own period, and the agreement assigned a specific portion of the federal settlement to each set of allegations.

The agreement assigned $18,956,151 to the federal government, $448,800 to Tennessee and $23,619 to Ohio. The federal portion included suspended Medicare payments already held by the government for Avalon’s Chattanooga operation, which the agreement allowed it to retain.

For someone who worked through an acquisition, the branch and the care period may be more recognizable than the corporate name on the settlement announcement.

What Are the Lawsuits Against Gentiva Hospice?

The resolution brought together nine False Claims Act qui tam actions filed by current and former employees. The federal government and Tennessee joined the Tennessee cases over Avalon.

That is why a former Avalon or SouthernCare employee may recognize the conduct without recognizing Gentiva as the name under which they worked. The settlement connects those branch-level accounts to the businesses that agreed to pay.

What Happens If a Hospice Patient Lives Longer Than Six Months?

A patient can continue receiving hospice care when recertification supports a prognosis of six months or less if the illness runs its normal course. Medicare’s hospice coverage manual expressly allows benefits to continue when a patient lives longer than expected.

The benefit provides two 90-day periods followed by unlimited 60-day periods, with fresh certification for each. The physician’s narrative must reflect the individual patient’s clinical circumstances. That makes the information reaching the physician central to an eligibility case.

The choice affects a patient’s treatment, too. Electing hospice means giving up Medicare payment for curative treatment of the terminal illness and related conditions, while coverage for unrelated conditions continues.

In Avalon’s case, the government alleged a failure to provide or adequately consider complete and accurate information. For an employee who saw a patient improve, the useful connection is between that observation, what reached the physician and the decision to keep billing.

Why a Long Hospice Stay Pays

Medicare pays a hospice a daily rate for every day a patient is enrolled, even on days when no one visits. Care costs tend to be highest around admission and death, with lower costs between them. That makes a long stretch of limited services financially attractive.

The HHS Office of Inspector General examined this incentive in its 2015 study, Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities. Analyzing Medicare hospice claims from 2007 through 2012, it found longer care and higher payments for beneficiaries in assisted living than in other settings. The report put the incentive plainly:

A 2026 Kansas State University working paper, Quality, Reputation, and Reimbursement Design in the Hospice Industry, examined how payment affects care through a model of California hospices. It measured quality using visits per patient day and found that combining payment per day with payment per visit could lower Medicare spending while maintaining the model’s level of quality.

In the Gentiva settlement, the government’s allegations concern how particular branches admitted patients, supported their continued eligibility and handled money already received. Connecting those decisions to the hospice bills is where an insider’s account becomes valuable.

SouthernCare New Beacon and the Referral Arrangement

The Gadsden, Alabama component concerned alleged payments for Medicare referrals through consulting agreements. The agreement allocated $362,000 of the federal settlement to this conduct, covering October 1, 2016 through October 1, 2022.

New Beacon disclosed the arrangement to the HHS Office of Inspector General itself. The government alleged that payments under a physician consultant agreement and an independent consultant agreement were intended to induce referrals to SouthernCare New Beacon’s Gadsden location, violating the Anti-Kickback Statute, and that Medicare claims followed.

This hospice referral kickback allegation follows the money paid to bring patients through the door. An employee handling consultant invoices or referral relationships may see the arrangement behind the incoming patient list. The physician’s contract, the payments and the resulting referrals tell that part of the story.

Curo had also been among the companies in the 2017 Hospice Plus kickback settlement, which required $12.21 million. That case alleged sham loans, free rent and other benefits for referrals, showing how referral payments can sit inside ordinary-looking business arrangements.

What Insiders Can See Behind the Claim

A separate case against Caris Healthcare shows how instructions inside a hospice can shape the clinical record behind a healthcare claim. Caris agreed to an $8.5 million settlement in 2018 over allegations that included ineligible patients and retained overpayments after internal warnings. The nurse who brought that case alleged:

The alleged instruction makes the problem concrete. A doctor reading a chart cannot weigh an improvement the chart leaves out. In the Avalon allegations, the government likewise focused on the completeness and accuracy of the information used for certification, followed by the response to internal complaints and audits.

Hospice whistleblowers can see different parts of that chain. Nurses know the patient’s condition. Clinical managers see admission and discharge decisions. Billers see the claims, and compliance staff see what happened after someone raised a concern. We work with you to connect what you saw to the instructions and payments behind it.

The Settlement and the Whistleblower Reward

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Happened Inside the Branch

If you saw patients kept on service, warnings ignored or consultant payments tied to referrals, talk with our whistleblower experts about the decisions behind the claims. We build the case with you and bring in hospice fraud whistleblower lawyers who understand clinical records, repayment failures and referral arrangements. We stay beside you from the first account of what happened through the pursuit of a recovery.