Judge sides with AseraCare in $200 million false claims suit

A federal judge in Alabama dismissed the government's charges against a national hospice provider, noting that the opinion of one medical expert is not enough for the government to prove the provider submitted false claims to Medicare.

In her memorandum opinion, Karon Bowdre, chief U.S. district judge for the Northern District of Alabama, said the government's case against AseraCare, which accused the company of submitting more than $200 million worth of false claims to Medicare, "boils down to conflicting views of physicians" about whether patients were eligible for hospice services.

Bowdre granted a new trial in October after finding the court "incorrectly instructed the jury on the falsity element," and required prosecutors to provide additional evidence that AseraCare submitted false claims. Ultimately, Bowdre determined that the government "backed itself in a corner" by relying exclusively on the opinion of one medical expert.

The whistleblowers are expected to appeal the decision; however a Department of Justice spokesperson declined to comment when asked if the government would contest the decision, according to AL.com. 

Many believed that the AseraCare case would have broad implications for hospice providers, particularly as it relates to when and how patients qualify for hospice services. Hospice providers have faced increasing scrutiny from the government over the last several years, capped off by a recent Office of Inspector General report that found Medicare spent $268 million on inappropriate hospice claims in 2012.

To learn more:
- here's the AseraCare decision
- read the AL.com article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.