The district court dismissed and the Sixth Circuit Court of Appeals affirmed the dismissal of a Qui Tam relator’s claim that our client defrauded the government by billing Medicare and Medicaid for (allegedly) poor quality radiology studies. The Sixth Circuit made two important rulings which will significantly limit claims under the FCA. First, it ruled that a healthcare provider does not violate the FCA by billing for medical services that did not meet a medical standard of care, unless those services were of no value. Second, it ruled that, except in unusual circumstances, a plaintiff must identify specific false claims in detail to bring a claim under the False Claims Act. This requires allegations of “(1) ‘the time, place, and content of the alleged misrepresentation,’ (2) ‘the fraudulent scheme,’ (3) the defendant’s fraudulent intent, and (4) the resulting injury.”
See Chesbrough, et al. v. VPA, P.C. (6th Cir. August 23, 2011)