Bradley attorney Brad Robertson was quoted in Bloomberg on a court ruling to restrict the testimony of two expert witnesses in a false claims case against three skilled nursing facilities and a rehabilitation provider. The whistleblower in the case had proposed that the witnesses testify about the facilities’ allegedly fraudulent actions and their alleged cost to the government. The decision shows that more pressure is being put on whistleblowers to show individual examples of fraudulent activity—when making allegations about the lack of medical necessity underlying claims submitted to Medicare—rather than making broad determinations based on a small statistical sampling.
“This decision shows the pitfalls of divorcing a medical necessity False Claims Act case from the actual medical decision-making for individual patients,” said Robertson. “Both of the experts offered opinions about whether care was fraudulent without doing any kind of sufficient review or analysis of the care provided to the individual patients in question. Defendants should keep an eye out for these kinds of shortcuts and mistakes in expert methodology that may open the door for a successful Daubert motion.”
The complete article, “Expert Witnesses Stifled in Medical Necessity Fraud Case,” appeared in Bloomberg on July 17, 2018.