Court Rejects Qui Tam Attack on Standard On-Call Contract

On June 10 the Third Circuit affirmed a lower court’s dismissal of a physician’s qui tam action against Pottstown Memorial Medical Center (PMMC) for violating the Anti-Kickback Statute (AKS) and False Claims Act (FCA).  And it’s a good thing because the basis of his claim was an on-call coverage arrangement …

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False Claims Charges vs. Eye Clinic Sufficiently Specific

Michael Sorenson is an optometrist formerly employed by Outreach Diagnostic Clinic.  After he quit, he filed a False Claims action against the eye clinic and the two doctors who owned it.  He alleged that the clinic routinely billed Medicare for tonography (i.e., eye pressure) tests that were never performed and …

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No Good Deed Goes Unpunished

Oscar Wilde observed, “No good deed goes unpunished.”  Whistle-blower Michael Cascio discovered the truth of that saying when a federal court threw out his qui tam case against a national wound care provider that partners with some 800 hospitals across the country. Mike and two others alleged that …

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Qui Tam Defendant’s Confidentiality-Breach Counterclaim Fails

What if a whistleblower discloses the protected health information (PHI) of privately insured patients in making the claim that his employer submitted false Medicare claims?  And what if that violates a confidentiality agreement the whistleblower signed with the employer?  Does the employer have a counterclaim …

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Supremes Hear Argument on Implied Certification Theory

On April 19 the U.S. Supreme Court heard oral argument in Universal Health Services v. U.S. ex rel. Escobar.  That’s the case in which the First Circuit upheld a whistleblower suit brought against a mental health clinic that had treated their daughter.  Their theory is that the clinic’s reimbursement …

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OK to Exaggerate How Long Patients Need Device

Today’s riddle:  Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices?  The answer is so simple that you’ll be embarrassed that you didn’t get it right away. Whistleblower Jeffrey …

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