Second, Presnell ruled that the False Claims Act isn't triggered just because some of the patients' medical records lacked a doctor's valid order to admit the patient.
“The court's ruling … is consistent with many other cases where courts have held that violating the Medicare conditions of participation regulations is not enough to establish False Claims Act liability,” said Jesse Witten, a Washington partner with Drinker Biddle & Reath. “This is the first decision to point out that the physician-order requirement was a condition of participation.”
Just last year, the CMS revised its regulation to clarify that a physician's valid admitting order is a “condition of payment” from Medicare, and not a condition of participation, Witten said.
“A condition of participation alone cannot and should not give rise to FCA liability,” said Brian Roark, a lawyer in the Nashville offices of Bass Berry Sims. “The government or relators will have to prove these types of cases based on the merits of whether the underlying documentation supported the claim billed—and not simply whether there was some technical violation with the claim.”
Even though Presnell's decision may have clarified the law in favor of hospital defense teams, healthcare providers may not see any resulting drop in False Claims Act lawsuits.
Houston-based Duane Morris attorney Michael Clark, chairman-elect of the American Bar Association's Health Law Section, said changes to the law in 2009 and 2010 made it easier to bring and maintain False Claims Act cases against healthcare providers.
But, he added regarding the Halifax ruling, “The law remains unsettled and this certainly is a prominent case.”
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