BC Advantage - 2020 Issue 1
AseraCare: Falsity and the False Claims Act
On September 9, 2019, the United States Court of Appeals for the 11th Circuit issued its decision in the case of United States v. AseraCare, Inc. et al. (938 F.3d 1278). The case centered on the circumstances under which a claim may be deemed "false" for purposes of the federal civil False Claims Act (FCA). In a decision favoring defendants of FCA investigations, the 11th Circuit held that a provider's clinical judgment that a beneficiary is eligible for a Medicare benefit cannot be deemed "false" for purposes of the False Claims Act, "when there is only...
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