176 F. Supp. 3d 1282
N.D. Ala.2016Background
- This False Claims Act case concerns whether AseraCare knowingly submitted false Medicare hospice claims by certifying 123 patients as having a ≤6‑month life expectancy when the medical records allegedly did not support those certifications.
- The Government’s proof of falsity relied principally on one medical reviewer, Dr. Liao, who testified that the patients’ records did not support the Certifications of Terminal Illness (COTIs).
- AseraCare presented competing hospice experts and the certifying physicians who reviewed the same medical records and concluded the COTIs were supported.
- The court previously granted a new trial after concluding the jury instructions on falsity were incorrect and indicated it would sua sponte consider summary judgment on falsity evidence beyond Dr. Liao’s opinion.
- The Government submitted medical record excerpts and guidance documents but identified no objective documentary falsehoods, no falsified records, and offered no other admissible, non‑opinion evidence of falsity.
- The court found that the Government’s case on falsity rested solely on a dispute of medical opinion and granted summary judgment for AseraCare on the remaining Counts.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether submission of claims was objectively false | Gov: Medical records lack clinical support for the COTIs for 123 patients; Dr. Liao’s review shows falsity | AseraCare: Medical records contain support; certifying physicians and defense experts reasonably concluded COTIs were valid | Court: No — difference of medical opinion alone cannot prove objective falsity |
| Whether a single expert’s contrary opinion suffices to show falsity under the FCA | Gov: Dr. Liao’s expert opinion is sufficient to prove claims were false | AseraCare: One expert disagreement cannot override certifying physicians’ clinical judgment | Court: No — expert disagreement, without objective falsehood, is insufficient |
| Whether the Government pointed to objective, non‑opinion evidence of falsity | Gov: Offered medical record excerpts and LCD/guideline materials | AseraCare: No objective documentary falsity or incorrect relied‑upon information shown | Court: No — Government failed to produce admissible objective evidence beyond opinion |
| Whether summary judgment sua sponte is appropriate after grant of new trial | Gov: Opposed sua sponte summary judgment | AseraCare: Supported court’s consideration | Court: Sua sponte summary judgment appropriate; granted for remaining Counts |
Key Cases Cited
- United States ex rel. Parato v. Unadilla Health Care Ctr. Inc., 787 F. Supp. 2d 1329 (M.D. Ga. 2011) (FCA requires proof of an objective falsehood)
- Corsello v. Lincare, Inc., 428 F.3d 1008 (11th Cir. 2005) (FCA liability arises from submission of fraudulent claims, not mere regulatory noncompliance)
- Urquilla‑Diaz v. Kaplan Univ., 780 F.3d 1039 (11th Cir. 2015) (submission of a false claim is the sine qua non of an FCA violation)
- United States ex rel. Phalp v. Lincare Holdings, Inc., 116 F. Supp. 3d 1326 (S.D. Fla. 2015) (opinions or scientific judgments about matters on which reasonable minds may differ are not false)