The Ninth Circuit recently revived a False Claims Act suit against Medicare Advantage Organizations related to risk adjustment payments for Medicare Advantage plans in U.S. ex rel. Silingo v. WellPoint Inc. et al.
In this case, the district court dismissed the relator’s claims against the defendant MAOs, primarily as impermissible “group-pleading,” because the relator failed to allege the specific conduct of each MAO. The Ninth Circuit disagreed, finding that the relator sufficiently “pleaded a wheel conspiracy-like fraud in which [the company that contracted with the MAOs] was the ‘hub’ and the defendant MAOs were the ‘spokes,’” and that they played “the exact same role” in the alleged scheme.
