Organizations support an official review of the case, which addresses the exercise of clinical judgment of physicians working with hospice patients.
(Alexandria, Va) – Today, the National Hospice and Palliative Care Organization, along with National Association for Home Care & Hospice, American Health Care Association, American Academy of Hospice and Palliative Medicine, and American Medical Association, submitted an amicus brief in support of an official review of the Care Alternatives case by the United States Supreme Court.
In United States ex rel. Druding v. Care Alternatives, the Third Circuit Court of Appeals held that a reasonable difference of opinion between physicians concerning a hospice patient’s prognosis presents an issue that should be resolved by a jury. This judgment is contrary to the holding from a previous case in another Circuit Court, United States v. Aseracare, Inc., which held that good faith disagreement between physicians would not support a False Claims Act (FCA) lawsuit.
Under the Care Alternatives decision, physicians and hospices are exposed to FCA liability based on the reasonable exercise of clinical judgment, and juries with no medical training or knowledge could overrule that judgment. This could lead physicians and hospices to be more conservative in their prognostication just to avoid FCA liability, and eligible patients could be prevented from accessing the benefits of hospice care they are entitled to receive.
“The relationship between a physician and patient is sacred. In developing a relationship, physicians learn about the complete picture of their patient. This includes not only diagnostic information, but also familial, social, and emotional support structures,” said NHPCO President & CEO Edo Banach.
“CMS and Congress have supported the authority of physicians to determine hospice eligibility. Clinical judgment should reside with physicians and should not be subject second guessing by juries. This threatens the sanctity of one of the most important relationships patients have when they have a serious illness,” Banach added.
In the ensuing months, the U.S. Supreme Court will decide whether to review the case. If the case is accepted for review, additional briefs would be filed, and oral argument will be held.
As the leading organization representing integrated, person-centered healthcare, NHPCO gives ongoing inspiration, practical guidance, and legislative representation to hospice and palliative care providers so they can enrich experiences for patients and ease caregiving responsibilities and emotional stress for families.