Seventh Circuit Revives FCA Claims, Finding Whistleblower Had Personal Knowledge Of Questionable Billing Practices

Published: 2011-03-08 13:45:36
Author: American Health Lawyers Association

  The Seventh Circuit reversed February 18 a lower court’s dismissal of False Claims Act (FCA) claims lodged by a whistleblower against her former employer.

The lower court concluded that reports finding a large amount of claims for services not covered by Medicare and miscoded claims amounted to a public disclosure bar of the instant suit.

However, the appeals court disagreed, holding that reports documenting a significant rate of false claims by an industry as a whole—without attributing fraud to particular firms—do not prevent a qui tam suit against any particular member of that industry.

The claims at issue were instead based on the qui tam plaintiff’s personal knowledge of the defendant’s billing practices, the appeals court concluded.

Whistleblower Kelly Baltazar worked for four months as a chiropractor at Advanced Healthcare Associates. During this time, she noticed that staff added to her billing slips services that had not been rendered and changed the codes for services that had been performed.

Baltazar filed suit under the qui tam provisions of the FCA against Advanced Healthcare and Lillian Warden, the firm’s owner (collectively, defendants).