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Court: Difference of Opinion is Not Hospice Fraud

Posted on Monday, September 16, 2019 1:42 PM

The Eleventh Circuit Court of Appeals has partially upheld a decision that favors Arkansas based hospice provider AseraCare in a False Claim Act (FCA) and this decision affects the whole industry.  The ruling said that just because of a difference of opinion from a physician’s opinion on a patient’s prognosis does not indicate a falsity under the FCA.  The case was trying to determine if the live dismissal from hospice care was fraud or because of the inability to pinpoint a patient’s exact life expectancy.

“This 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,” AseraCare said in a statement.

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