Tuesday, April 5, 2016

District Court Holds Conflicting Medical Opinions Cannot Prove False Claim



In closely watched litigation, a federal district court judge struck down a $200 million False Claims Act (FCA) case against a hospice provider, “holding that the government’s second guessing of physicians’ medical judgment alone cannot prove false claims” (US ex rel Paradies v AseraCare). 

Last May, an Alabama federal district court judge granted AseraCare’s motion to divide its False Claims Act (FCA) trial into Phase I, which would focus on “falsity;” and Phase II, which would focus on “knowledge” and other FCA elements. Phase I was initiated, and after an eight week trial, Judge Karon Bowdre dismissed the case on March 31, 2016. Judge Bowdre held that much of the evidence in the trial consisted merely of conflicting expert testimony about patient eligibility, and the federal government failed to prove its case, as “[a] mere difference of opinion between physicians, without more, is not enough to show falsity.”

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