In a highly anticipated opinion in the AseraCare case, issued on September 9, 2019, the Eleventh Circuit Court of Appeals affirmed the district court’s holding that “a clinical judgment of terminal illness warranting hospice benefits under Medicare cannot be deemed false, for the purposes of the False Claims Act, when there is only a reasonable disagreement between medical experts as to the accuracy of their conclusion, with no other evidence to prove the falsity of the assessment.” U.S. v. AseraCare, Inc., No. 16-13004, at *3 (Sept. 9, 2019 11th Cir.) (“Op.”). Although the Court remanded the case to the district court to consider any such “other evidence” the Government might identify in the record, it also made clear that such evidence would need to “link” to specific claims submitted for payment, creating a substantial practical impediment to the Government’s ability to prove falsity in this and similar cases.
Regulations, Compliance, & Enforcement
Trending Now
Can Government Contractors Use AI? A Legal Guide to AI Compliance and Disclosure Requirements • The Government Contractor Code of Business Ethics and Conduct: Standards and Practices • Data Rights in Government Contracts: A Guide • Cybersecurity Compliance Remains a False Claims Act Risk Despite CMMC Phase II Suspension • Should Compliance Programs Relax When DOJ Enforcement Slows Down?
The Eleventh Circuit Remands AseraCare, But Affirms High Hurdle for Proving Falsity
Guschenkova | Shutterstock
Track False Claims Act cases, audit trends, and compliance best practices with our Compliance & Enforcement newsletter, delivering up-to-the-minute intelligence Monday–Saturday — Subscribe here.