Archives for False Claims Act

Extrapolating Liability in FCA Cases | Decisions of Medical Necessity

There is considerable hesitancy in the healthcare industry to rely on statistical sampling for questions deemed subjective in nature, or when the sampling units in a population might be considered too unique.  This generally manifests when attempting to extrapolate liability in litigation, particularly in FCA matters.  For instance, conclusions about a patient’s medical eligibility and/or the medical necessity for hospice care have been disputed in recent years when sampling analysis was the basis for such conclusions.

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Extrapolating Liability in False Claims Act Litigation; The Life Care Debate

Courts have generally accepted statistical sampling and extrapolation as evidence to estimate damages.[i] However, the use of sampling for purposes of establishing liability in False Claims Act (“FCA”) litigation is an issue of conflict between those prosecuting FCA claims and those defending such claims. In the decision in United States ex rel. Martin v. Life Care Centers of America, Inc., the Eastern District of Tennessee found sampling and extrapolation appropriate for the Government’s use in attempting to establish the elements of FCA liability.[ii] While that case settled for $145 million in 2016, this post offers an overview of the case, along with a summary of the Court’s decision and a discussion of its implications…

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