November 16, 2021
The Firm scored a major win this week when the United States Court of Appeals for the 7th Circuit declined en banc rehearing in U.S. ex rel. Prose v. Molina Healthcare of Illinois (Case No. 17-cv-06638), making only minor amendments to its August 20, 2021 opinion, reinstating relator’s qui tam lawsuit against managed care organization Molina Healthcare for violations of the federal False Claims Act (FCA) and its Illinois counterpart. The case was filed in the U.S. District Court for the Northern District of Illinois by FVLD client and whistleblower Dr. Thomas Prose, the founder of General Medicine, P.C., a team of board-certified physicians and advanced nurse practitioners specializing in treating patients residing in Skilled Nursing Facilities (SNFs).
The lawsuit seeks to recover overcharges to Illinois’ Medicaid program for expensive SNF-related services that were not provided. The District Court had dismissed the case in June 2020, which prompted the Seventh Circuit Appeal. In reversing that order, the 7th Circuit majority found, among other things, that the District Court “failed to give proper weight to the complaint’s description of Molina as a highly sophisticated member of the medical services industry” with knowledge of the capitated payment process.
The FCA imposes significant liability and penalties on persons and companies who defraud the federal government. Cases are initiated by whistleblowers, or “relators” who may prosecute the actions on the government’s behalf in exchange for a percentage of the recovery.