Defendants moved to dismiss a qui tam action, alleging the complaint didn’t demonstrate submission of a false claim. The court denied the motion. The relator had not asserted a specific submission, but submission could be inferred from the facts alleged.
United States ex rel. Merritt v. Amedisys, M.D. Ga., No. 7:21-cv-17
- The Alleged Fraud – A relator filed a qui tam action alleging defendants fraudulently billed Medicare, falsified certification forms, and improperly compensated physicians for referrals. The relator alleged various violations of the False Claims Act and Anti-Kickback statute.
- Motion to Dismiss – The defendants moved to dismiss for failure to state claim. The defendants said the relator had not pleaded fraud with particularity. The relator had pleaded a fraudulent scheme, but had not alleged the defendants actually submitted a false claim for payment.
- Implied Submission? – The court noted the heightened pleading requirements for an FCA claim require the plaintiff allege facts that show the defendants submitted a claim to the government. The relator’s claims didn’t include these details. Nevertheless, the court thought the complaint still met the pleading requirements. The relator had worked for the defendants for ten years. She witnessed false certifications and Medicare fraud. She regularly asked her employer how they could pay the claims and was told not to worry about. Taking these allegations as true, it logically followed the defendants were submitting false claims for payment.
–Case summary by Craig LaChance, Senior Editor
