An Alabama jury determined that hospice company AseraCare admitted Medicare beneficiaries who were not eligible for end-of-life care in order to get more Medicare dollars.
The jury considered whether individual medical records supported 121 hospice claims and found 104 of those claims to be false or unsupported. The case will now move to a second phase in which the jury will examine whether AseraCare knowingly submitted false claims. Such knowledge, or at least reckless disregard for the truth, is required to prove liability in False Claims Act cases.
If it loses, AseraCare could have to pay more than $200 million in damages, which would make it the largest False Claims Act case ever involving a hospice provider.
Federal law requires two physicians to certify that a person is likely to live no longer than six more months before that person can be eligible for hospice care.
Once beneficiaries enter hospice care they must give up curative care.
Jeffrey Newman represents whistleblowers.