Recently proposed amendments to the False Claims Act (FCA) could spell choppy regulatory waters for the hospice industry. Senators introduced a bill that would, among other provisions, shift the burden of evidence and potentially make it easier for whistleblowers to call out hospices on fraud and harder for providers to defend themselves, according to Bryan Nowicki, hospice attorney for Husch Blackwell.
Senators Dick Durbin (Dem. Ill.), Charles Grassley (Rep.-Iowa), Patrick Leahy (Dem-Vt.), John Kennedy (Rep.-La.) and Roger Wicker (Rep.-Miss.) introduced a bill that, if enacted, would amend FCA procedures regarding fraudulent hospice claims to Medicare that violate the program’s rules and regulations. The legislators proposed changes to the law’s parameters for determining materiality. “Materiality,” has several definitions depending on who you ask, but the defining factor is that a misstatement or misrepresentation could have influenced Medicare’s decision to pay or deny the claim.
The U.S. Senate Committee on the Judiciary is considering the bill, which also contains language that the materiality of an FCA claim can be established by a preponderance of the evidence, which means that the court believes that more than 50% of the claim is true.
The proposed changes could alter the way false claims are enforced to the detriment of hospice providers, according to Nowicki, raising the level burden for disproving materiality.
“To show immateriality, which is what the provider...
From False Claims Act exposure and Defense Federal Acquisition Regulation Supplement (DFARS—a supplement to the Federal Acquisition Regulations (FAR)),compliance to export controls and human rights...