Investigations Bulletin: Amici Calls for Dismissal of Qui Tam’s High Court Prosecution | Arent Fox Schiff

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Various medical, business and legal organizations are asking the United States Supreme Court to uphold the dismissal of a False Claims Act (FCA) lawsuit, submitting a number of amicus curiae pleadings to the Court in the case United States ex rel. Polanksy c. Executive Health Resources Inc. et al.

The case is before the Court on appeal from the Third Circuit’s decision in October 2021, which upheld the dismissal of parent Polansky’s lawsuit against Executive Health Resources Inc., based on a motion to dismiss filed by the U.S. Department of Justice (DOJ) — years later he initially declined to intervene in the lawsuit — in accordance with his legal authority to dismiss FCA whistleblower cases.

Polanksy had accused Executive Health Resources Inc., a health care billing review firm, of helping hospitals overburden federal health care programs. The DOJ decided to dismiss the case, arguing that it had “doubts about the petitioner’s ability to prove an FCA violation.” The Third Circuit upheld that rejection, despite the fact that the DOJ had not previously intervened in the case. Polansky now argues that the dismissal should be overturned so he can proceed with the suit, because the DOJ waived its right to seek the dismissal after initially refusing to intervene in the suit.

friends before the United States Supreme Court include the United States Chamber of Commerce, the American Health Care Association, and the American Hospital Association; The Law Foundation of Washington; and Pharmaceutical Research and Manufacturers of America. They argue that the FCA’s language “makes it impossible to guess the reasons for the government’s dismissal” because the FCA “allows individuals like Polanksy to sue on behalf of the United States as a way to advance the interests government, not to frustrate them.” friends explain that the FCA allows the government to retain control over suits that tam brought on behalf of the government by, among othersdismissing the action over the rapporteur’s objections, and that the Third Circuit’s dismissal was therefore appropriate.

The deal is United States ex rel. Polansky v. Executive Health Resources Inc. et al.No. 21-1052, before the Supreme Court of the United States. Read Law360 coverage here.

Texas doctor pleads guilty to $54 million Medicare fraud

On October 25, 2022, a Texas doctor pleaded guilty to his role in a $54 million Medicare fraud scheme.

According to the DOJ and court documents, the doctor ordered durable medical equipment and cancer genetic testing without seeing or treating patients. The doctor would have known that with these prescriptions, more than $54 million in false and fraudulent claims had been submitted to Medicare. From August 2018 to April 2019, the doctor reportedly received around $30 for every order he signed authorizing durable medical equipment and genetic tests that weren’t needed or not used, totaling more than 466,000. $ in bribes.

The DOJ alleged that Medicare beneficiaries were targeted by telemarketing campaigns and at health fairs, and pressured to receive cancer genetic testing and durable medical equipment regardless of medical necessity.

The doctor pleaded guilty to conspiracy to commit wire fraud and is expected to be sentenced on March 15, 2023. He faces a maximum sentence of 20 years in prison.

The DOJ press release is available here.

Colorado man charged with $1 million fraud in COVID-19 PPP

On October 26, 2022, the U.S. Attorney’s Office for the District of Colorado announced that a Colorado-based man had been arrested after being indicted by a federal grand jury for his involvement in a Check Protection Program fraud scheme. payroll (PPP) of one million dollars.

According to the indictment, from April 2020 to September 2021, the accused submitted fraudulent PPP applications to seven banks and one lender for emergency financial assistance to deal with the economic impact of the COVID-19 pandemic. The PPP claims, which the defendant submitted on behalf of a number of business entities it claimed to control, misrepresented that all PPP funds received would be used to pay eligible business expenses. Defendant obtained over $1 million in PPP loans as a result of these false and fraudulent claims; rather than using PPP funds for eligible business expenses, the indictment alleged that the defendant used PPP funds for his personal benefit, by purchasing, among other things, real estate and vehicles.

The defendant then requested loan forgiveness for the PPP loans by submitting applications for loan forgiveness. According to the indictment, the defendant also made false statements regarding his businesses and his compliance with PPP program requirements, including requirements related to the use of PPP loan funds.

The defendant was indicted for electronic fraud and money laundering, and made his first appearance before an investigating judge on October 26, 2022.

The DOJ press release is available here.

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