Capital Caring hospice pays $3.1M federal settlement following Medicare billing investigation

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

release.

"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.

Tweet David Beard @dbeardtdp Email [email protected]

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