Private Equity Hospice Fraud: What Elara and Kindred Agreed to Pay

Private equity hospice fraud can involve billing Medicare for ineligible patients and keeping overpayments after warnings reach management at an investment-owned chain. The hospice fraud settlements involving Elara Caring and Kindred Hospice placed payment obligations on named operating companies and holding companies. A nurse may know who refused a discharge. A compliance employee may know who received the audit. Those decisions give the ownership question its substance.

Who Owns Hospice?

Within a chain, the brand, the company billing Medicare, its holding company and the investment firm can carry different names. Tracing hospice ownership means connecting those names to the dates of the care and the decisions being questioned.

The history behind Gentiva shows why the dates matter. Humana and private equity firms acquired Kindred Healthcare in 2018, and Curo Health Services joined Kindred at Home that July. Humana bought the remaining interest in 2021.

In August 2022, Humana sold a 60 percent interest in the hospice and personal-care business to Clayton, Dubilier & Rice, retaining 40 percent. The business took the Gentiva name.

Elara’s agreement identifies a different corporate chain. Before July 2018, JHH/CIMA Holdings owned and operated the Texas hospice subsidiaries. The settling group included BW Homecare Holdings, JHH/CIMA Holdings and the CIMA hospice companies.

For an employee looking at an old claim or audit, the provider number and location are practical anchors. The Kindred agreement identifies its Warwick, Rhode Island, operation as Odyssey Healthcare Operating B. The Elara agreement identifies the Texarkana provider as CIMA Hospice of Texarkana. A familiar brand and an unfamiliar company name can lead back to the same hospice.

What Did Elara Settle?

Elara Caring agreed to pay $4,200,000 to resolve allegations that it billed Medicare for ineligible hospice patients and improperly retained overpayments, principally for care in Texarkana from January 2014 through December 2019. The Justice Department announced the resolution on May 1, 2024, after a former employee brought a whistleblower case.

The settlement agreement also covers particular patients treated in Texarkana, El Paso and Sherman. Its allegations concern both unsupported hospice claims and money Medicare had already paid.

The employee’s complaint describes how problems surfaced inside the business. The whistleblower alleged that patients lacked signed hospice election statements even while Elara billed Medicare. Management allegedly proposed obtaining missing signatures later and backdating the documents to admission. The complaint alleged that some patients had already died without signing.

The complaint also alleged that an internal audit identified ineligible patients at the New Braunfels office. On the missing election paperwork and the recommendation to report improper payments, it described this response:

That alleged response puts the management decision in view. The employee had identified a payment problem and raised it.

What Did Kindred, Curo and Gentiva Settle?

The Kindred resolution required $19,428,570 and resolved allegations raised in nine whistleblower actions. Announced in July 2024, it covered ineligible hospice patients, retained overpayments and a separate physician-referral arrangement. The agreement names the companies responsible for payment, including Curo Health Services Holdings, Gentiva Certified Healthcare Corp. and the hospice operating companies it groups under Kindred.

The Tennessee allegations concerned Avalon Hospice in Nashville and Chattanooga, covering January 2010 through February 2020. In its complaint announcement against Curo, the government alleged that the companies failed to ensure certifying physicians received and considered complete, accurate information about patients’ conditions. It also alleged that internal complaints and audits identified ineligible patients, yet the companies kept the Medicare and Medicaid payments.

The agreement also covers eligibility and retained-payment allegations at other Kindred and SouthernCare locations. Each allegation stays tied to a provider, branch and treatment period, which matters to an employee whose work predates the name now on the office.

SouthernCare New Beacon supplied a separate part of the resolution. The company disclosed a physician consulting arrangement at its Gadsden, Alabama, location. The government alleged that payments under consulting agreements were intended to induce hospice referrals. That part concerns how patients reached the hospice.

Part of the federal settlement was $7,761,156 in Medicare payments the government already held after suspending payments to Avalon’s Chattanooga operation. Kindred agreed to give up its claim to that money.

Did the Private Equity Firm Pay?

The agreements require the named hospice companies and holding companies to pay. Elara’s signers include BW Homecare Holdings and the CIMA companies. Clayton, Dubilier & Rice is not a named payer in the Kindred agreement.

Yet both agreements extend protection from specified government claims to current and former corporate owners and parents once the payment conditions are met. The companies receiving that protection reach beyond the companies named on the bill.

The insider’s question then becomes concrete: who received the eligibility warning, who controlled the response and who authorized continued billing or keeping the money? An instruction from branch management, a report sent to a holding company and a decision made by an investment firm are distinct links to establish. We work with the employee who knows where that decision traveled.

Why the Enrolled Day Matters to the Business

Medicare’s daily hospice payment ties revenue to the time a patient remains enrolled. Routine home care pays for each enrolled day, including days without a visit. Care costs tend to be higher around admission and death, with a less expensive stretch between them. A delayed discharge can therefore keep revenue coming.

When a hospice keeps payments for ineligible patients after internal warnings, taxpayers fund enrollment that the clinical record cannot support.

The HHS Office of Inspector General explained in its 2015 study of hospice care in assisted living facilities that providing minimal services over a long period can increase a hospice’s financial gain. That incentive helps explain why an admission target or a disputed discharge belongs beside the patient record.

The March 27, 2026 version of the Kansas State University working paper Quality, Reputation, and Reimbursement Design in the Hospice Industry examines the business incentive to invest in care:

In its model of California hospices, the paper found that stronger reputation effects increased patient visits, while lower Medicare reimbursement reduced them. The analysis makes the actual operating choice worth examining: what happened to staffing, visits and clinical decisions when management pursued its financial targets?

What Evidence Is Needed to Prove Fraud?

In healthcare fraud cases, useful evidence connects the patient’s condition, the Medicare claim and what management knew. Across changes of ownership, we help connect those decisions to the companies responsible at the time.

A nurse may recognize hospice eligibility problems in a chart that conflicts with the certification. A compliance employee may have seen an audit warning followed by retained hospice overpayments. Curo’s physician-information allegations show why the original assessment and what reached the certifying physician both matter. These are different views of the same health care business, and we work with you to connect them.

The same sequence appears in Caris Healthcare. The government alleged that internal audits, nurses and the chief medical officer raised eligibility concerns, yet the company continued billing and took no meaningful action to determine whether it had received improper payments. The warning and the response help explain how a clinical concern became a company decision.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We connect your knowledge of the care, the claims and the management response to the companies involved.

You Know Where the Warning Went

If you worked in hospice care, billing or compliance and saw management overrule a clinical concern or keep payments after an audit, speak with our whistleblower experts about who made that decision. We build your case around the people who knew, the claims they approved and the companies behind them, and stay beside you as the case develops. We bring in hospice fraud whistleblower lawyers who understand eligibility disputes, retained overpayments and changes in ownership.