Qui Tam Quarterly: Strategies for Avoiding the "Battle of the Experts" in False Claims Act Cases Based on Medical Necessity

K&L Gates LLP

Medical necessity cases continue to be a focal point for False Claims Act (FCA) investigations and lawsuits. With this focus comes an age-old problem for health care providers and entities defending these actions: the so-called “Battle of the Experts.” In these types of cases, the U.S. Department of Justice (DOJ) and/or a relator challenge a diagnosing doctor’s opinion that a procedure or service was medically necessary. As a result, the complaint alleges that the follow-on reimbursement claim submitted to the applicable federal health care program was “false” for the purposes of the FCA. A successful defense in these cases may ultimately hinge simply on whether the jury believes (or likes) the plaintiff’s or the defendant’s testifying expert more.

Please see full Publication below for more information.

LOADING PDF: If there are any problems, click here to download the file.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© K&L Gates LLP | Attorney Advertising

Written by:

K&L Gates LLP

K&L Gates LLP on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.