Hospice Corporate Integrity Agreements: What Settlements Require After the Headline

A hospice corporate integrity agreement requires a provider to carry out monitoring, billing reviews and corrective work negotiated with the Department of Health and Human Services Office of Inspector General after a fraud settlement. For someone inside the hospice, the important question is what happened after an audit found the problem. Did the company change the billing, address the patient eligibility findings and follow through on its promises? Medicare pays the unsupported claims, draining money meant for patients at the end of life.

The Office of Inspector General describes the bargain plainly. The provider keeps access to Medicare, Medicaid and other federal health care programs in exchange for corrective work and outside scrutiny of its billing. It can keep billing the programs whose money it allegedly misspent. These agreements typically last five years. They carry a hospice fraud settlement into the company’s daily operations, where the next admission, certification and claim will be made.

Hospice Corporate Integrity Agreement Eligibility Review

Hospice corporate integrity agreement eligibility review concerns the clinical support for patients receiving the hospice benefit. Medicare eligibility rests on a prognosis of six months or less if the illness runs its normal course, with certification and later recertification. The supporting patient information matters because it is what the physician has to work with.

The payment system gives that review a particular purpose. Medicare pays for each enrolled day, including days when nobody visits. Costs tend to be highest at admission and near death, with a less expensive stretch between them. Routine home care accounted for 98.8 percent of Medicare-covered hospice days in 2024. Keeping someone enrolled keeps the daily payment coming.

Review of admission and recertification decisions reaches the chart, the physician’s information and the company’s response when staff question continued eligibility. A discharge recommendation that goes nowhere can be as revealing as the original admission decision.

The level of care presents a separate billing question. Continuous home care addresses an acute crisis requiring skilled nursing at home. General inpatient care addresses pain or symptoms that cannot be managed in another setting. The higher hospice billing level must match the care the patient needed and received. That is why eligibility findings and level-of-care findings keep appearing together in hospice enforcement.

VITAS and the People Above the Chart

VITAS’s agreement extended oversight to independent review, board resolutions and management certifications. That reaches the people responsible for the system in which the claims are produced. Clinical staff may supply the patient record, but management controls the targets, staffing and response to problems.

In its October 2017 settlement announcement, the Justice Department alleged that VITAS rewarded employees for the number of patients receiving hospice services without regard to whether they were terminally ill. It also alleged goals for continuous home care days billed to Medicare, aggressive marketing and pressure on staff. The continuous care allegedly included services that were unnecessary, never provided or performed outside Medicare requirements.

Those allegations explain why oversight has to reach above the clinician who signs a note. A billing target originates somewhere. So does a decision to keep using it after clinical staff object. Board resolutions, management certifications and independent reviews give an insider different accounts of how the company says it is addressing those risks.

Odyssey and the Audit Finding That Needed an Answer

Odyssey HealthCare’s 2012 resolution paired a settlement of $25 million with a new corporate integrity agreement. The Justice Department alleged unnecessary continuous home care and services that did not meet Medicare requirements. Former employees brought the whistleblower cases. Odyssey had already entered an earlier agreement, effective in 2006.

One complaint alleged that the company had already received a clear warning from its own audits:

The allegation connects the audit result to the decision about what to do with it. A review can identify unsupported care and still leave the same billing practices in place. The reviewer’s findings, the people who received them and the claims submitted afterward belong in the same account.

A separate Odyssey complaint alleged that a nurse assigned to one continuous-care patient was simultaneously assigned to other hospice patients. That makes the comparison concrete: the staffing assignment, the service record and the billed level of care should describe the same work. Someone responsible for the schedule may understand a discrepancy that a claim alone cannot explain.

Harmony Care’s Owner Had an Agreement Too

Harmony Care Hospice’s owner had a separately listed integrity agreement alongside the company’s. The obligations could reach the person running the business as well as the business itself.

The November 2012 settlement announcement alleged that Harmony and its owner knowingly billed Medicare for patients who lacked the required terminal prognosis. The owner was individually responsible for $200,000 of the settlement. The government said both the company and its owner accepted federal monitoring and reporting requirements.

For an insider, that changes whose conduct belongs in the picture. An instruction from ownership, the response to a clinical objection and the account given to the monitor can all concern the same decision. Responsibility for carrying out the agreement need not stop at the compliance department.

Kindred and Kona Paid for Failures After Signing

The Office of Inspector General can enforce the agreement itself when a provider fails to carry out its obligations. Kindred’s case shows what that looks like after repeated internal warnings. Hospice of Kona’s shows that missing the deadlines for getting monitoring started can produce a penalty.

Kindred’s Audits Found Problems That Continued

Kindred paid a penalty of more than $3 million for failing to comply with its corporate integrity agreement, the Office of Inspector General announced in September 2016. The company was in the fourth year of its agreement, and OIG’s unannounced visits found continuing violations.

Required internal audits had found unimplemented policies, poor claims practices and Medicare overpayments. OIG said Kindred billed for patients who were ineligible for hospice or for the highest-paying level of service. The audits were finding the problems. The company’s response was failing to put them right.

The Inspector General also reported corrective work: stronger internal audits and investigations, and tracking the resolution of identified issues. Kindred closed 18 sites it described as underperforming following the audit findings. The meaningful comparison runs from the finding to the response, then to what happened in the affected operations.

A 2009 Journal of Forensic & Investigative Accounting study, Medicare Billing Risk Perceptions of Hospitals Operating Under Corporate Integrity Agreements, surveyed hospital management about healthcare billing risks. Managers at hospitals under agreements assigned higher risk ratings to the billing schemes than managers at hospitals with voluntary compliance programs. Kindred’s enforcement history brings the question back to action: once the company recognizes the risk, what changes?

Kona Missed the Deadlines for Monitoring

Hospice of Kona paid a $9,500 stipulated penalty in July 2019. The Office of Inspector General said Kona missed the deadlines for appointing a compliance officer, posting the required notice, engaging an independent review organization and submitting its implementation report.

The missed deadlines concerned the basic oversight Kona had promised in its Integrity Agreement: who would oversee compliance, who would review the claims and how the provider would account for implementation.

The Agreement’s Term and OIG Closure Are Different Dates

Final reporting and the Office of Inspector General’s review are part of finishing an agreement. For VITAS and Kona, the listed closure dates fell after their stated terms. The final report matters because it describes how the provider carried out its obligations.

MJHS Settled and Refused the Agreement

MJHS Hospice and Palliative Care agreed to a $5,225,000 settlement over allegedly unsupported continuous home care and general inpatient care, yet refused a corporate integrity agreement. The Office of Inspector General recorded the refusal under heightened scrutiny in August 2020.

What an Insider Can Connect

The useful evidence connects the patient record, the claim and the company’s response to a known problem. A clinical reviewer may know which patients were recommended for discharge. A biller may know that claims continued. A compliance employee may know how the finding was described to management and whether the corrective work ever happened.

We connect chart changes, audit findings and management messages to establish who knew about unsupported billing and what happened afterward.

That is the knowledge hospice whistleblowers can bring to a case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When the Findings Never Changed the Billing

If you saw a hospice keep billing after reviewers identified unsupported care, talk with our whistleblower experts about what happened inside the company. We connect the clinical findings, the billing and the management decisions into a focused case strategy, and bring in hospice fraud whistleblower lawyers who understand those connections. We stay beside you as your knowledge of what happened becomes the foundation of the case.