Partner Lawrence Kraus was quoted in a Medscape article, “Physicians Misjudge a Terminal Patient’s Life Span: Is It Fraud?” about whether a physician’s honestly held clinical judgment regarding hospice certification can be false under the False Claim Act based solely on a reasonable difference of opinion among physicians.
Kraus, who defends health care providers in FCA cases, said the issue is also important in FCA cases against other types of health care providers, including hospitals, because physicians make all kinds of clinical decisions that trigger payments by Medicare, Medicaid, and other government health insurance programs.
“This will spill over to many other types of physician clinical decisions,” he said. “Clinical judgment comes up in almost every instance because the Medicare statute requires that the service provided be reasonable and necessary.”
