Dive Brief:
- A false claims case involving the DOJ and AseraCare came to a controversial conclusion last week when the federal judge ruled in favor of the hospice care provider regarding internal whistleblowers' false claims allegations.
- The DOJ's case argued AseraCare had knowingly submitted claims to Medicare for patients not eligible for end-of-life care.
- The company successfully argued it was reasonable for physicians to disagree about a patient's eligibility for hospice care.
Dive Insight:
The case raised eyebrows because of the way it was handled by the judge after she threw out a jury's decision from October 2015 and made the opposite decision.
U.S. District Court Judge Karon Owen Bowdre wrote, “When hospice certifying physicians and medical experts look at the very same medical records and disagree about whether the medical records support hospice eligibility, the opinion of one medical expert alone cannot prove falsity without further evidence of an objective falsehood.”
However, some suggest the case was laid out in an unusual way that prevented consideration of other evidence that supported allegations of fraud, and, as a result, the decision is likely to be overturned on appeal.
Mary Inman, a partner at Constantine Cannon, who is not involved in the case, told Modern Healthcare that in her almost 20 years of practice she has never seen a fraud case that was split into two parts to separately address whether the claims were false, and whether they were knowingly submitted.
Inma nsays that prevented some evidence from being presented during the first part, and that following the decision of the first part, there will be no second part.
The DOJ filed a complained against AseraCare in 2012 saying the national provider with about 65 hospice providers in 19 states (e.g. Alabama, Georgia, Pennsylvania, and Wisconsin) had violated the False Claims Act by misspending "millions of taxpayer dollars intended for Medicare recipients."