tci Medicare Compliance & Reimbursement - 2003 Issue 7

False Claims Act: CONTRACTORS DON'T HOLD THE BAG FOR PROVIDER FALSE CLAIMS

Whistleblowers can’t sic the False Claims Act on Medicare contractors simply for approving payments that a health care provider submitted fraudulently. So ruled the 11th U.S. Circuit Court of Appeals in the Jan. 28 decision U.S. ex rel Saralosa v. Aetna (No. 01-14291). The feds had put players involved in a scam perpetrated by now-defunct Florida home health agency St. Johns HHA through the wringer, including numerous trials starting in 1999. But two former St. Johns employees have been trying to put fiscal intermediary Aetna Life Insurance Co. on the hook for FCA penalties as well...

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