Q: Hospital ->hospice fraud. Is hospital discharge summary with non-existent admission diagnosis legally false claim?

A: Under California law, a hospital discharge summary containing a non-existent or false admission diagnosis that is used as the basis for hospice certification and to receive government benefits could potentially be considered a false claim.

The California False Claims Act (CFCA) prohibits knowingly submitting false or fraudulent claims to the state or local government for payment or approval. This includes using false records or statements to get a false claim paid or approved.

Key points to consider:

1. If the hospital discharge summary contains a fabricated or non-existent terminal admission diagnosis, it could be deemed a false record.

2. If this false record is provided to the hospice and used to certify the patient for hospice care, resulting in the hospice receiving government benefits, it may constitute a false claim under the CFCA.

3. The CFCA also prohibits conspiring to commit any of the acts prohibited by the law, which could potentially apply if the hospital and hospice knowingly collaborated to use the false diagnosis for hospice certification and to obtain government benefits.

4. The lack of patient authorization for sharing the hospital discharge summary with the hospice may also raise concerns about potential violations of patient privacy laws.

However, it's important to note that the specific circumstances of each case would need to be carefully evaluated to determine if a false claim has occurred under the law. Consultation with an attorney specializing in healthcare fraud and false claims would be advisable to assess the legal implications of the situation you described.