Bradley attorney Jason Mehta was quoted in Bloomberg on a decision from a U.S. Court of Appeals that medical judgment couldn't be used at the summary judgment stage as a defense in a false claims action against a healthcare provider that allegedly billed for medically unnecessary treatments. The appeals court found that a claim based on an inappropriate exercise of medical judgment can be considered false under the FCA, which should put providers on notice that this liability theory is not going away.
“For providers, this is somewhat of an ominous development,” said Mehta. “The fact the Tenth Circuit is expressly reviving a case that at its core is about medical necessity and judgment is potentially ominous for providers.”
Mehta said the decision could allow more whistleblowers to at least reach discovery. He also cited as significant the government's decision to express interest in the case at the appeals court level despite declining to intervene at the federal trial court level.
“Where the DOJ has either intervened or filed statements of interest, courts are much more accommodating to those relators,” Mehta explained. “Now more than ever, relators counsel need to get the buy-in of the DOJ.”
The complete article, “Medical Judgment Not Valid False Claims Defense, Court Says,” appeared in Bloomberg on July 12, 2018. (login required)