The relator alleged that the defendant intentionally sought overinflated reimbursements from Medicare, Medicaid, and private health insurance. The defendants moved to dismiss, but the relator’s claims survived.
United States ex rel. Schieber v. Holy Redeemer Healthcare System Inc., et al., D. New Jersey, No. 19-12675
- Falsity: The relator alleged that the defendant’s software as a service (SaaS) was intentionally designed to raise revenues by selecting a higher number of patient visits. Thus, the SaaS application effectively generated factually false claims. The defendants argued the relator’s allegation did not satisfy the falsity element of an FCA claim. The court, however, found the allegations sufficient.
- Knowledge: The defendants argued the relator admitted that the defendants might not have had actual knowledge of every time the software prompted an increase of patient visits. The court determined that the relator sufficiently pleaded that the defendant deliberately ignored or recklessly disregarded the false information coded on its software.
- Other Claims: The court dismissed the relator’s conspiracy claim for being too vague and dismissed the state law claim for failing as a matter of law.
Case summary by Joshua Lim, Assistant Editor
