Eleventh Circuit Rules in AseraCare Case that Disagreements in Clinical Judgment, Without Objective Falsity, Do Not Prove Fraud Under the FCA

The U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited and closely watched decision in United States v. AseraCare Inc. The court ruled that a claim cannot be deemed false under the False Claims Act based on a difference in clinical judgment.  Instead, there must be proof of an objective falsehood. More than three years have passed since the U.S. District Court for the Northern District of Alabama issued the series of rulings that gave rise to the Eleventh Circuit case.

For at least two reasons, this case has captured the attention of both the FCA defense and the relators’ bars and triggered legal attacks on the part of DOJ.  First, the rulings followed a peculiar procedural path, as discussed below. Second, the district court weighed in on the closely followed question of whether, in FCA cases based on allegations of lack of medical necessity, physicians’ clinical disagreements are sufficient to allege falsity and found that, absent objective falsity, they were not.

Read the full article at Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.