Feds Gain Advantage in Biggest-Ever Hospice False Claims Case

The U.S. government has scored a win in a case that may result in the biggest False Claims Act penalty ever involving a hospice provider.

In the first phase of the trial — which was divided into two phases — the jury examined whether individual medical records supported 121 hospice claims and found that 104 of those claims were unsupported or false. The case now is set to move on to a second phase in which the jury will look at allegations that AseraCare pressured doctors and nurses to sign up patients and keep them under Medicare-funded hospice care.

AseraCare has disputed the allegations in court documents, claiming that reasonable minds can differ in evaluating whether a patient is eligible to receive hospice care.

The case is seeking to determine whether AseraCare, a subsidiary of Plano, Texas-based Golden Living, admitted Medicare beneficiaries who were ineligible for end-of-life care in order to rake in more money. Individuals can legally be considered for the Medicare hospice benefits only if they are diagnosed as terminally ill with a life expectancy of six months or less.

AseraCare operates approximately 60 hospices in 19 states, with about 10,000 patient admissions every year, court documents reveal.

If a federal jury in Alabama finds against AseraCare, the hospice agency could ultimately have to pay more than $200 million, including fines and additional penalties, according to AL.com.

Written by Mary Kate Nelson