A doctor brought a qui tam action, alleging that the owner of several health care businesses had submitted false certifications to Medicare, for the businesses were engaged in the “unlawful corporate practice of medicine” and referrals among the businesses were unlawful. In affirming a lower court’s dismissal of this action, the Ninth Circuit ruled that the relator’s complaint did not spell out the allegations in sufficient detail. See U.S. ex rel. Ebeid v. Lungwitz, 2010 WL 3092637 (9th Cir. Aug. 9, 2010).

Notably, the Ninth Circuit, in rejecting the lower court’s reading of the law, held that the relator does not need to identify representative examples of false claims to support every allegation. Instead, the Court of Appeals ruled that it was sufficient to allege particular details of a scheme to submit false claims, as long as these details were paired with “reliable idicia that lead to strong inference that claims were actually submitted” to the government. The Ninth Circuit found that the relator failed to meet even this standard, for he failed to state which particular laws were violated by the defendant’s activities.

Oftentimes, False Claims Act cases turn on a violation of a controlling law or regulation. It is the job of experienced relator’s counsel to help identify the applicable laws and regulations.

For more information about qui tam law and health care fraud, contact Nolan & Auerbach, P.A.