In what could be the death knell for a decade-long False Claims case, a federal appeals court has rejected a nurse’s allegations that the nursing home chain he worked at for two months had committed years of intentional understaffing and overbilling.
Registered nurse Philip Hunter alleged Golden Living Centers, Fillmore Capital Partners and nine related owners engaged in a “scheme to routinely overbill Medicare and Medicaid” at 273 nursing homes. But a US District Court judge last year threw out his claims, writing that they were grossly short on evidence and relied on mathematical estimates and broad statements from workload and computer simulation experts that did not advance proof of an organized scheme.
Hunter asked the US Court of Appeals for the Third Circuit to overturn the dismissal, but it roundly rejected his efforts in a Monday opinion.
“To meet the pleading standard of Federal Rule of Civil Procedure, the plaintiff must allege ‘particular details of a scheme to submit false claims paired with reliable indicia that lead to a strong inference that claims were actually submitted,’” a three-judge panel wrote, citing previous case law.
The lower court “determined that these allegations were too ‘vague,’ otherwise ‘insufficient to provide reliable [evidence] of fraud,’ … or in some cases, entirely inconsistent with Hunter’s claim of fraud,” the opinion said. “We agree.”
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