The Supreme Court refused to hear an appeal from Molina Healthcare that should have ended a False Claims Act case brought by a former business partner and may have raised the bar for lawsuits. whistleblower in the future.
Tuesday’s high court decision cleared the way for a whistleblower to pursue his allegation that the Medicaid insurer charged Illinois and the federal government for nursing home services they failed to provide. .
Molina asked the court to review the lower court’s decision in February, arguing that the complainant’s complaint lacked enough detail to meet the legal standard required for Complaints Act cases. complaint Sai. If the Supreme Court took up the case, it would “have a severe impact on the litigation burden” of such claims and set a new precedent, according to a court order published in June.
The Supreme Court did not provide an explanation for the decision not to hear the case. Molina did not immediately respond to a request for an interview.
A group of providers filed a lawsuit in 2017 in the U.S. District Court for the Northern District of Illinois, alleging that Molina misrepresented the performance of their skilled nursing facility service contract to increase sales. revenue they generate from the Illinois Medicaid program.
Thomas Prose, CEO of a Novi, Michigan-based post-acute medical practice called General Medicine, alleges that Molina who charged Medicaid for doctor and nurse visits did not happen. General Medicine clinicians have previously oversaw care for Molina Medicaid members living in post-acute care facilities. The vendor group ended its contract with Molina in 2015 after the parties were unable to come to terms on reimbursement rates.
However, thereafter and through at least April 2017, the plaintiff alleges that Molina failed to replace the care coordination services that General Medicine had previously provided but continued to receive reimbursement from Medicaid up to $3,000 per enrollee per month for violating federal and Illinois law. Molina’s Medicaid policy requires the insurance company to provide skilled nursing coordination services to enrollees, and regulators have allowed the insurer to participate in the Illinois Medicaid program for a period of time. based on the provision of those services, according to the complaint.
The district court dismissed the case in June 2020, ruling that Prose did not point to cases where Molina knowingly lied about the level of her services or misrepresented her Medicaid services. The U.S. Court of Appeals for 7th Street reversed the lower court’s decision in August 2021 and ordered the records to be returned to the district court.
