Health Care Law Blog
On March 31, 2016, the United States District Court for the Northern District of Alabama granted summary judgment for AseraCare in one of the largest False Claims Act (FCA) lawsuits against a hospice provider. In this whistleblower case, the government sought over $200 million, alleging that defendant AseraCare overbilled Medicare for hospice services by falsely certifying that patients were eligible for hospice care.
The litigation began when six AseraCare employees in Alabama, Wisconsin and Georgia (the "relators") filed whistleblower cases under the FCA. The employees alleged that AseraCare knowingly submitted false claims to Medicare by falsely certifying that patients met the Medicare eligibility requirements for the hospice benefit. In order to be eligible for the Medicare hospice benefit, a patient's physician must certify that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course." 42 C.F.R. § 418.22(b)(1). The Department of Justice (DOJ) intervened in January 2012.
The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached resolution agreements and corrective action plans with two health care entities - a health system and a research institution - in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). These cases underscore the importance of ongoing HIPAA compliance vigilance by covered entities and business associates, particularly in light of OCR’s recent announcement that it has commenced Phase 2 of its audit program.
The Michigan Health Insurance Claims Assessment Act is back for reconsideration before the United States Court of Appeals for the Sixth Circuit. The act imposes a tax on paid health care claims that is used to fund the state share of Michigan’s Medicaid program. The act had been upheld by the federal appeals court in 2014 against an ERISA preemption challenge brought by an organization representing self-insured group health plans and third-party administrators.
The Supreme Court recently remanded the case to the federal court of appeals for reconsideration in light of a decision holding that a Vermont all-payers claim database statute interfered with the uniform administration of ERISA plans and was therefore preempted.
