A national hospice provider was involved in a Medicare fraud case brought under the federal False Claims Act by the U.S. Department of Justice (DOJ). The DOJ, acting on three whistleblower reports, alleged that our client had submitted false claims to Medicare for hospice patients who were not eligible for the Medicare hospice benefit. The DOJ based its claims on a retrospective review of the medical records by a physician who disagreed with the judgment of the patients’ doctors and hospice physicians who had certified that the patients were terminally ill and thus eligible for hospice care under Medicare.
Following trial, judgment was granted to our client. The judge concluded that the evidence, which pointed only to a difference in opinion among physicians, was insufficient to establish that the hospice provider had submitted false claims.