Dist. Ct. erred in dismissing plaintiff’s qui tam lawsuit under False Claims Act, alleging that plaintiff’s former employer fraudulently billed Medicare and Medicaid for services performed by its anesthesiologists, who, according to plaintiff, regularly billed government using code for “medically directed” services when their services qualified for payment only at lower rate for services that were “medically supervised.” While magistrate judge ultimately found that plaintiff failed to satisfy Rule 9(b)’s heightened pleading standards, Ct. of Appeals found that plaintiff had satisfied said standards, when ten examples of subject bills provided sufficient particularity about alleged fraudulent billing to survive dismissal. Fact that plaintiff lacked access to relevant billing records and was unable to identify specific false invoices was not fatal to plaintiff’s lawsuit, where: (1) plaintiff alleged that he had direct knowledge of entry of false coding procedures; and (2) plaintiff provided examples of fraudulent billing that identified procedures from specific doctors that should not have been billed at higher medically directed rates.
Federal 7th Circuit Court
Civil Court
False Claims Act