Where summary judgment was awarded to a defendant in a qui tam Medicare fraud case, that judgment should be affirmed because the relator has failed to present any evidence through which a reasonable jury could find in its favor on the essential element of scienter.
“Today, we’re reckoning with a qui tam Medicare fraud case arising under the False Claims Act (‘FCA’), 31 U.S.C. §3729 et seq. On its face, this appeal has a bit of everything: a labyrinthine regulatory structure, a fraud-hunting doctor, an alleged ‘smoking gun’ email exchange, and a lot of information — perhaps more than most readers would care to know — about urinary tract infection (‘UTI’) tests.
“But behind all that fanfare, the question we face is straightforward: did OMNI Healthcare (our relator/appellant) produce enough evidence that MD Labs (our main defendant/appellee) ‘knowingly’ submitted false Medicare claims to avoid the summary judgment scythe? … The district court said ‘No.’ We agree. …
“Like we said at the start, the question on appeal is rather narrow: did OMNI produce enough evidence that MD Labs ‘knowingly’ submitted a false claim to survive summary judgment? … Like the district court, we think not. …
“So we hold (as a matter of first impression in the First Circuit) that in FCA cases alleging Medicare fraud based on laboratory testing, generally a laboratory can rely on a doctor’s order to show that the test is ‘reasonable and necessary’ under 42 U.S.C. §1395y(a)(1)(A). The burden then shifts...
Where summary judgment was awarded to a defendant in a qui tam Medicare fraud case, that judgment should be affirmed because the relator has failed to present any evidence through which a reasonabl...