In their reporting on the long-awaited decision in a False Claims Act case brought by the United States against hospice provider AseraCare, Inc., the Report on Medical Compliance spoke with Drinker Biddle partner Jesse Witten on the ruling and what it means for providers.
On September 9, 2019, the U.S. Court of Appeals for the Eleventh Circuit issued its decision in the FCA case United States v. AseraCare, Inc., ruling that it takes more to prove false claims than a physician disputing the eligibility of patients for Medicare services after the fact.
While the decision is good news for providers on the medical necessity and FCA fronts, Witten noted that the appellate court also ruled that hospice claims could be false if there’s evidence that physicians rubber-stamped certifications, as a witness alleges in the AseraCare case.
“It’s a difficult decision to sort out because there’s something for everybody,” he added.
According to Witten, “the message for hospice providers is they need to ensure the physician is certifying patient life expectancy is not longer than six months and that they truly reviewed the clinical information before they made that judgment.”
