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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U.S. Sides with Defendant Against Whistleblower—Sort of

Today’s riddle: why would the government take the defendant’s side against the whistleblower in a False Claims Act qui tam case?  Why would the government challenge the whistleblower’s claim that two defendants violated the Stark Law, insisting instead that they met a Stark exception? A Georgia federal …

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Retaliation Claim Survives Though False Claim Act Claim Is False

Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans.  When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving all preauthorization requests for durable medical equipment.   She complained that the …

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Most Imaginative Whistleblower Claim of the Month

Vicki Sheldon is the hands-down favorite to claim this month’s Most Imaginative Whistleblower Claim award.  Vicki’s at-the-time husband Duane was employed at Kettering Health Network (KHN).  Duane had an affair with another KHN employee, and the two of them impermissibly accessed Vicki’s medical records.  …

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A Grossly Negligent Claim Isn’t a False Claim

You have to feel sorry for whistleblower Darilyn Johnson.  The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her basic FCA case.  Darilyn could prove that when the allergy clinic filled out its Medicare …

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