A case against hospice company AseraCare has begun in order to determine whether the company cheated Medicare by enrolling patients who were not eligible. To qualify for the government Medicare hospice benefit, a patient must be certified by both their primary care physician and a hospice doctor as being within six months of dying if the disease follows its normal course. The patients must give up seeking a cure in exchange for receiving care to kill the pain and make them comfortable in their remaining days.
Six former AseraCare employees from Alabama, Georgia, and Wisconsin had filed whistleblower lawsuits claiming the company had pressured employees to enroll as many people as possible into its hospice program and then billed Medicare for it. The claims were consolidated for one trial in Birmingham.
The Government’s lawyer said the government’s expert, Dr. Solomon Liao, Director of Palliative Care Services with the University of California, Irvine, reviewed the 123 cases and found four patterns over and over again with the patients: chronic but not terminal; inaccurately evaluated; improving; and treatable conditions.
AseraCare’s lawyer argued that no human knows whether someone is going to live less than six months. An attorney for the DOJ, however, told jurors that AseraCare got patients who weren’t really within six months of dying to give up seeking a cure for ailments “ñ many of them chronic or treatable – and to sign up for hospice. “This is a case about trust,” he said.
If the Birmingham jury finds against AseraCare, the company could ultimately be on the hook for more than $200 million including fines and other penalties, making it the largest False Claims Act lawsuit ever against a hospice company.
Jeffrey Newman represents whistleblowers but not in this case.