Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Legal
February 27, 2020 03:10 PM

AseraCare to pay $1 million to settle False Claims Act case

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Modern Healthcare Illustration / Getty Images

    Hospice provider AseraCare on Thursday said it settled a closely watched False Claims Act case with the federal government for $1 million.

    The lawsuit hinged on whether a physician's medical judgment can be deemed false based only on another physician's conflicting opinion. The settlement will not require a corporate integrity agreement, the Plano, Texas-based company said in a statement.

    The Justice Department and attorneys representing AseraCare on Wednesday filed joint stipulations of dismissal of the case in a federal court in Alabama.

    The requests followed twin setbacks to the government's case last year. In September, the 11th U.S. Circuit Court of Appeals upheld the lower court's ruling that a False Claims Act action cannot be based solely on reasonable disagreement between the government's medical expert and the provider's medical expert, with no other evidence to prove the falsity of the claim.

    Then in December, U.S. District Judge Karon Owen Bowdre in Alabama denied the government's motion to reopen discovery in the case, saying that simply bringing in another medical expert to question the AseraCare physicians' clinical judgment would essentially be futile.

    The Justice Department's case was based on whistleblower claims filed in 2008 by three former AseraCare employees. They alleged that the hospice provider had filed Medicare claims for patients who did not meet the CMS' eligibility requirement of having no more than six months to live.

    Privately held AseraCare operates 44 hospice facilities in 14 states.

    Over the past several years, the government has pursued FCA lawsuits against several hospice companies as concerns have grown over rising rates of hospice admission and growing lengths of stay.

    Some attorneys said the outcome of the case will make it harder for the government to bring FCA cases based solely on having physician experts challenge providers' medical decisions, and the impact could extend beyond just hospice cases.

    "When dealing with medical necessity decisions, the government will have a little higher standard to prove falsity," said Jacinta Alves, a partner at Crowell & Moring who was not involved in the case.

    The Justice Department did not issue a statement by deadline.

    Jim Barger Jr., an attorney for the whistleblowers, said the settlement showed AseraCare would have lost the FCA lawsuit.

    "It chose to pay rather than allow the case to proceed to a jury again," he said.

    In its news release, AserCare said the settlement will give more clarity to the hospice industry in FCA cases. IT also said that the 11th Circuit opinion "provides comfort for the physicians who are making these difficult determinations related to terminally ill patients as well as the hospice providers who are reimbursed by Medicare for services for these patients."

    In 2016, a jury found 104 of AseraCare's hospice claims to be false or unsupported. But Judge Bowdre tossed that verdict, saying her jury instructions had been incorrect. She later issued a summary judgment in favor of AseraCare, which the government appealed.

    In September, the 11th Circuit largely upheld her ruling but remanded the case to her to consider whether to allow the government to present broader evidence of false claims.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    supreme-court-healthcare-ok_WEB_i.jpg
    Healthcare groups react to Supreme Court abortion ruling
    blue-gavel-with-money2_i.png
    Supreme Court sides with HHS, not hospitals, in DSH payment case
    Sponsored Content
    Daily Dose Newsletter: Sign up to receive a late afternoon weekday roundup of that day’s breaking news and developments in healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing