National News

AseraCare’s False Claims Act win—Appeals judge says ‘reasonable’ clinical opinions can’t be fraud
A major hospice provider is praising an appeals court decision that agreed a clinical judgment cannot be deemed as fraud under the False Claims Act based on a difference of physician opinions. ...“Nonetheless, under all these unusual circumstances, it is only fair that the government be allowed to have summary judgment considered based on all the evidence presented at both the summary judgment and trial stages, and we direct that this occur,” court documents stated. The district court’s post-verdict grant of summary judgment in favor of AseraCare was vacated and the case was remanded for further consideration.[Editor’s Note: To read the AseraCare press release, click here.]

NHPCO Statement on 11 Circuit Court Decision
On December 31, 2014, NHPCO filed an Amicus Brief with the U.S. Court of Appeals for the Eleventh Circuit regarding a False Claims lawsuit and what constitutes a falsity under the FCA. This brief was filed by NHPCO with support of many in the entire provider community. Providers may remember the case, which ultimately debates the authority of a Medical Director to be confident that medical decisions made in good faith and grounded in medical science should not be questioned and reversed years after the fact. NHPCO’s Amicus Brief argued that a “disagreement among physicians as to an individual’s terminal prognosis based on a review of the individual’s medical record give rise to a FCA violation, ignores the well-recognized difficulty of accurately predicting the end of life and threatens to undermine Congress’s goal of ensuring access to the Medicare hospice benefit where a physician has concluded, in his or her clinical judgement, that a patient is terminally ill.” … Putting aside the merits of this particular case, NHPCO wants to reinforce among the provider community that a mere difference of opinion does not constitute falsity under the FCA.

Feds Ask for $38M Judgment in Record-Setting Nursing Home Fraud Case
When the man at the center of a record-setting nursing home fraud case faces a sentencing hearing this week, he’ll also be staring down a nearly $39 million recovery judgment. The federal government has asked a judge to approve a plan that would force Philip Esformes, convicted earlier this year on 20 fraud-related counts, to forfeit $38.7 million in funds gained through his money laundering crimes. …

Capital Caring Pays $3.1 Million to Resolve Medicare Billing Claims
Capital Caring, located in Falls Church, has agreed to pay $3.1 million to settle allegations that it caused the government to overpay the organization as a result of billings it submitted to the Medicare Program for hospice services. … The overpayments were the result of claims Capital Caring submitted to Medicare for hospice services for patients who the government alleged either did not meet the hospice eligibility guidelines for the Medicare Program, Title XVIII of the Social Security Act, or for whom the hospice clinical record information maintained by Capital Caring was insufficient to support Medicare hospice coverage.

Hospices Engage Virtual Reality in Staff Training
An increasing number of hospice providers are incorporating virtual reality (VR) technology into their staff training. Hospice of Southern Maine is one of those organizations. In 2018, they were approached by Embodied Labs, one of the leading vendors of this technology in the health care space. The idea was to collaborate on a new VR module that deals with end-of-life situations.

Home Health Care Training Programs Popping Up As Caregiver Crisis Worsens
In the midst of an increasingly dire caregiver crisis, 2019 has seen a number of labs and training programs launch for home-based care workers and nurses. Among the latest is thanks to LHC Group Inc. (Nasdaq: LHCG), which teamed up with South Louisiana Community College (SLCC) to form a new home health lab that will expose college nursing students to the field.

Hospice Employees Need Cybersecurity Training
Health care organizations, hospices included, continue to be prime targets for hackers and other cybercriminals, leading to data breaches that disclose protected health information and cause potentially huge financial losses. Despite the risks, most health care providers do not have adequate protections in place, according to a new report by cybersecurity watchdog Kapersky. … Kapersky engaged the research firm Opinion Matters to conduct an online survey of 1,758 health care workers, of whom 1,004 worked in the United States and 754 worked in Canada. Close to one-third of respondents said that they had never received any kind of cybersecurity training from their workplace and said they felt that they should have.

Palmetto GBA Update

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