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Hospice Health Care Providers Appeals

Husch Blackwell LLP

Hospice Insights Podcast - Hospice Audit Updates: Hospices Fare Well in Federal Court

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Increasing audit activity combined with certain decreasingly favorable audit appeal outcomes has resulted in hospices appealing audit results beyond the administrative law judge phase and into federal court. In this episode,...more

Husch Blackwell LLP

Hospice Audit Series | Painting the Picture: How to Advocate for Clinical Hospice Eligibility in the Audit Appeal Process

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The core of most hospice audits has been, and continues to be, whether the medical record supports the patient’s hospice eligibility. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki and Zaina Niles...more

Bass, Berry & Sims PLC

Fifth Circuit Affirms Criminal Healthcare Fraud Convictions of Hospice and Home Health Executives

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On March 24, the U.S. Court of Appeals for the Fifth Circuit affirmed the criminal healthcare fraud convictions of two individuals who ran a network of home health and hospice centers in Texas. According to the Fifth Circuit,...more

Husch Blackwell LLP

Drumroll Please: The Latest on HIS Appeals

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In this episode, Husch Blackwell's Meg Pekarske chats with colleagues Bryan Nowicki and Jacob Harris, who share what happened with the Hospice Item Set (HIS) noncompliance letters. You have to listen—did hospices win or lose?...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 30. News Briefs: August 2020

Report on Medicare Compliance 29, no. 30 (August 24, 2020) - A federal court on Aug. 17 blocked HHS from enforcing its revised definition of sex discrimination in Sec. 1557, which prohibits discrimination on the basis of...more

Husch Blackwell LLP

COVID-19 Hasn't Interrupted Everything: Certain Hospice Audit Activity Continues Despite Public Health Emergency

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COVID-19 threw a wrench into certain hospice audit activity, but the machine rumbles on. In today’s podcast episode, Husch Blackwell's Meg Pekarske, Erin Burns and Bryan Nowicki discuss the current state of hospice audits,...more

Husch Blackwell LLP

Is the Aseracare precedent in jeopardy? Courts Questioning Clinical Judgment Standards

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The 2019 Aseracare Court of Appeals decision was lauded by hospices as appropriate push-back to overly aggressive whistleblowers and government enforcers. Its central holding, that two physicians can reasonably disagree about...more

Husch Blackwell LLP

Is the Aseracare Precedent in Jeopardy? Courts Questioning Clinical Judgment Standards

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The 2019 Aseracare Court of Appeals decision was lauded by hospices as appropriate push-back to overly aggressive whistleblowers and government enforcers. Its central holding, that two physicians can reasonably disagree about...more

Morgan Lewis - Health Law Scan

Mere Differences of Judicial Opinion Emerge to Muddle Healthcare Providers False Claims Act Exposure for Mere Differences of...

In the Care Alternatives False Claims Act (FCA) appeal, a panel of the US Court of Appeals for the Third Circuit on March 4 reversed the summary judgment granted to hospice provider Care Alternatives at the district court,...more

Holland & Knight LLP

AseraCare Announces Settlement of Landmark False Claims Act Case for $1 Million

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After litigation spanning more than a decade, hospice provider AseraCare announced its $1 million settlement with the U.S. Department of Justice (DOJ) in a closely-watched False Claims Act (FCA) case in the U.S. District...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

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All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more

King & Spalding

AseraCare Case Illustrates the Importance of Internal Compliance

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On September 9, 2019, the Eleventh Circuit issued a highly anticipated opinion addressing the question of when Medicare claims for reimbursement (in this case, claims for hospice care) can be considered “false” under the...more

Latham & Watkins LLP

11th Circuit: Difference in Opinion Not Enough for FCA Liability

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The 11th Circuit’s long-awaited AseraCare opinion requires more than mere disagreement regarding clinical judgment to prove falsity under the False Claims Act. The 11th Circuit rejected the government’s theory of falsity...more

Baker Donelson

Disagreements over a Medical Judgment Cannot Form the Basis for Liability Under the False Claims Act

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A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more

Foley Hoag LLP - White Collar Law &...

Eleventh Circuit Holds Differences in Clinical Judgment Do Not Create FCA Liability for Hospice Provider

The Eleventh Circuit agreed with the trial court that the government must do more than present expert evidence that a physician’s clinical judgment was inaccurate to establish falsity under the False Claims Act. Nonetheless,...more

Foley & Lardner LLP

AseraCare 11th Circuit Case Holds Differences in Hospice Clinical Opinions are Insufficient to Demonstrate Falsity Under the FCA

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Tuesday’s ruling by the United States Court of Appeals for the Eleventh Circuit in United States v. AseraCare is a win for hospice and other health care providers who have long argued that a mere difference of clinical...more

Morgan Lewis - Health Law Scan

Eleventh Circuit Shows the Way in Aseracare Decision: Why Mere Differences of Clinical Opinion Cannot Be Fraud Under the False...

The US Court of Appeals for the Eleventh Circuit has issued its much awaited decision in United States v. Aseracare, and for those who question how mere differences clinical opinion can ever support punitive False Claims Act...more

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