In the AseraCare case, the United States Department of Justice (DOJ) sought to show that AseraCare submitted false claims. Relying upon a single medical expert, the DOJ attempted to show patients’ medical records do not contain “clinical information and other documentation that support [this] medical prognosis,” and thus, AseraCare’s claims for those patients were “false.” In rejecting the DOJ’s case and granting Summary Judgment for AseraCare, the Court held that reliance on a single medical expert was insufficient to demonstrate that a company submitted false claims.
AseraCare is a national healthcare company that provides both hospice and palliative care related services. The care aimed at relieving pain, symptoms or stress of terminal illness, includes a comprehensive set of medical, social, psychological, emotional and spiritual services. Under the Medicare rules, elderly patients may qualify for hospice, palliative care, and other medical only if the particular patient is deemed to be “terminally ill” by way of a Certification of Terminal Illness (“COTI”). Medicare defines a COTI as “a life expectancy of 6 months or less if the terminal illness runs its normal course.”
Read Full Article in the September 2016 Issue of Life Science Compliance Update