The Fifth Circuit affirmed dismissal of a whistleblower’s False Claims Act case alleging false Medicare billing, finding the claims lacked factual support and particularity.

The Court of Appeals for the Fifth Circuit affirmed the district court’s dismissal with prejudice of a whistleblower’s qui tam action under the False Claims Act (FCA). The relator, a former sales representative at a rehabilitation hospital, alleged that the facility submitted false Medicare claims by allowing non-clinical employees to influence patient admission decisions. The Fifth Circuit held that the complaint failed to allege sufficient facts or particular details showing that false claims were submitted or that any alleged misconduct was material to government payments. The Fifth Circuit also upheld the denial of further leave to amend, concluding that any amendment would be futile (U.S. ex rel. Gentry v. Encompass Health Rehabilitation Hospital of Pearland, L.L.C., No. 25-20093 (5th Cir. Nov. 3, 2025)).

Medicare rules allow non-clinical involvement. The relator argued that the hospital’s process for preadmission screenings (specifically the use of non-clinical staff in gathering and drafting screening narratives) violated Medicare requirements and resulted in improper reimbursements. The Fifth Circuit disagreed, emphasizing that Medicare regulations expressly permit non-clinical personnel to collect information for screenings, provided that clinicians make the ultimate admission decisions. The...

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