Whistleblowers tried to convince Tuesday an appeals court to reopen a False Claims Act suit alleging that Care Alternatives Inc. defrauded Medicare by providing hospice care to patients who weren’t eligible.
Counsel for the whistleblowers—former Care Alternatives employees—asserted that a New Jersey federal district court improperly rejected the suit for lack of materiality. The whistleblowers didn’t show that the company’s alleged failure to provide proper medical certification for the services affected Medicare’s payment decisions, Judge Juan R. Sánchez said in a December 2021 ruling.
That decision was incorrect because a jury could determine that a medical professional’s written certification is necessary for Medicare to receive the benefit of its bargain with a care provider, Ross Begelman of Begelman & Orlow PC argued before the US Court of Appeals for the Third Circuit’s panel.
Judges Cheryl Ann Krause, Stephanos Bibas, Marjorie O. Rendell participated in the panel.
“It’s a condition of payment that you have to have records to support your claim,” Begelman said.
Patients weren’t eligible for hospice care because they lacked documentation—that is the essence of the bargain with the government, he said.
“Whether they needed hospice is irrelevant,” he said. The issue is whether they were qualified for care, and they weren’t qualified without...
Over the last year, beyond traditional healthcare and federal procurement matters, the government has pursued federal False Claims Act (FCA) investigations and enforcement across high-risk areas, i...