A recent case out of the Northern District of Illinois Federal Court, US ex rel. Oughatiyan v. IPC the Hospitalist Company, Inc., demonstrates the high risk inherent in evaluation and management (E&M) coding for health care providers.... Continue Reading →Tags: 9(b), E&M, evaluation and management, False Claims Act, FCA, hospitalist, Illinois, IPC, Northern District of Illinois, Oughatiyan, Seventh Circuit
In U.S. ex rel. Grenadyor v. Ukranian Village Pharmacy, Inc. et al., the Seventh Circuit affirmed a trial court’s dismissal of a whistleblower’s complaint for its failure to provide sufficient specificity regarding the alleged fraud. In the opinion, Judge Posner drives a stake through the heart of a common boilerplate phrase with clarity and... Continue Reading →Tags: 7th Circuit, 9(b), dismissal, Illinois, motion to dismiss, particularity, pleading, Posner, Seventh Circuit
Last week, the 11th Circuit Court of Appeals issued its unpublished ruling in US ex rel. Mastej v. Health Management Associates, Inc. At issue was whether the relator’s Third Amended Complaint adequately pled fraud with particularity, as required by Fed.R.Civ.Pro. 9(b). Mastej was an Health Management Associate (“HMA”) executive from 2001 to... Continue Reading →Tags: 11th Circuit, 9(b), AKS, Anti-Kickback, Eleventh Circuit, False Claims Act, FCA, fraud with particularity, Health Management Systems, HMS, Mastej, Stark