Federal Courts Continue to Refine Particularity Requirements Under the False Claims Act

Posted on Health Care Law News by Robert Nicholson

In one of the latest opinions from a Federal Circuit Court of Appeals on the issue of the particularity required of a whistleblower in bringing a False Claims Act case, the First Circuit Court of Appeals allowed a case to proceed with allegations regarding a single false claim.  The Court commented that with respect to the allegations of thousands of additional false claims submissions, there was “no reason to suspect that physicians did not seek reimbursement” for the allegedly defective product, and “it is also highly likely that the expense is not one that is primarily borne by uninsured patients.”  The Court continued that it was “virtually certain that the insurance provider in many cases was Medicare, Medicaid, or another government program.” Because “it is statistically certain,” that the defendant “caused third parties to submit many false claims to the government, we see little reason . . . to require Relators to plead false claims with more particularity than they have done here.”

Although this case is not a complete departure from the requirements in the Eleventh Circuit case law regarding pleading false claims with particularity, it represents a continued willingness of federal appellate courts to allow False Claims Act cases to proceed with limited evidence of particular false claims.

The case was also noteworthy because it represents an additional case where a federal appellate court has allowed a False Claims Act case to proceed on the theory that the billing for the use of a defectively manufactured medical device by a physician or hospital results in an actionable false claim case against the manufacturer of the defective product.

The attorneys at Nicholson & Eastin, LLP regularly handle False Claims Act cases.  If you have a False Claims Act matter, please feel free to call us to discuss your case.