The relator managed to connect alleged upcode overcharging to the submission of bills to the government that would have necessarily contained inflated charges.
A qui tam relator who did not plead a specific example of a false claim managed to allege specific fraudulent conduct supporting an inference that health care providers submitted false claims to Medicare and Medicaid, found the federal district court in Baltimore, Maryland. Essentially, the relator left little doubt that if the providers implemented the alleged upcoding scheme, they would have necessarily billed the government for false claims. The court accordingly held the complaint met the Fed. R. Civ. P. 9(b) standard for particularized pleading. Furthermore, group pleading was not fatal to claims against individual physicians where allegations of working “in concert” supported a plausible inference that they all knew invoices were inflated, false, and submitted to various insurers. The court denied the health care providers’ motion to dismiss in all respects (United States ex rel. Hayden v. Graw, No. 1:14-cv-02379-ELH (D. Md. Jul. 20, 2026)).
Background. In this qui tam action under the False Claims Act (FCA) and, initially, the Maryland False Claims Act, Md. Code § 2-601 et seq., the former chief financial officer of a medical office administrative support company alleged that certain physicians and health care provider entities (collectively, the providers) engaged in a scheme to inflate bills for patient...
The relator managed to connect alleged upcode overcharging to the submission of bills to the government that would have necessarily contained inflated charges. A qui tam relator who did not plead ...