Organizations Mentioned:Cotchett Pitre & McCarthy, LLP | King & Spalding, LLP | Quest Diagnostics | Quest Diagnostics Inc.

A relator alleged a laboratory test provider submitted bills to government without knowing if tests were medically necessary, but did not identify any particular patient whose tests were not, in fact, medically necessary.

A relator whose qui tam False Claims Act complaint alleged diagnostic laboratory test provider Quest Diagnostics Inc. engaged in a fraudulent billing scheme by charging Medicare and Medicaid for tests it did not know were medically necessary, failed to meet the particularity requirement for pleading her claims, the United States Court of Appeals for the Eleventh Circuit has held. The court affirmed a district court’s dismissal of the claims, agreeing with the lower court that while the relator generally alleged a scheme whereby Quest submitted to Medicare and Medicaid bills for laboratory tests it did not know were medically necessary, her complaint was deficient because she did not identify any particular instance where Quest submitted a bill that in fact included medically unnecessary tests. Therefore, she failed to plead the fraud with particularity as required, the appellate court held. The appellate court also affirmed the dismissal of the claims without giving the relator leave to amend (U.S. ex rel. Senters v. Quest Diagnostics Inc., No. 24-12998 (11th Cir. July 16, 2025)).

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