On December 7, 2010, the U.S. District Court for the District of Kansas refused to dismiss False Claims Act (FCA) claims against a hospice provider.
The defendant, Hospice Care of Kansas, Inc. (HCK), which was purchased by defendant Voyager Hospicecare, Inc. in 2004, provides hospice care to Medicare beneficiaries. The suit contends that the defendants submitted Medicare claims for ineligible hospice patients and followed business practices that caused the “admission, retention, and submission of claims to Medicare for patients that were ineligible for the hospice benefit.”
In arguing that the complaint fails to state a claim, the defendants argue that a medical opinion regarding whether a patient is terminally ill–meaning they have a life expectancy of less than six months–is a subjective medical opinion that cannot be false. But the court noted that “facts that rely upon clinical medical judgments are not automatically excluded from liability under the FCA.”
In refusing to dismiss the complaint, the Court noted that the complaint identifies 27 hospice beneficiaries alleged not to be terminally ill, but for whom defendants submitted Medicare claims. The complaint also sets forth factual details underlying the patients’ alleged false certifications, the claims submitted by defendants, and the reimbursements paid by Medicare.
The recent hospice-related Medicare fraud cases demonstrate the increasing complexity of the regulatory environment surrounding the hospice benefit for Medicare recipients. For more information regarding the Medicare hospice benefit, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at The Health Law Partners, P.C. at (248) 996-8510.