Medicare Coding FCA Decision Is A Plausibility Reminder

Law360 (August 29, 2019, 5:21 PM EDT) -- The recent federal court opinion issued by the U.S. District Court for the Western District of Texas in Integra Med Analytics LLC v. Baylor Scott & White Health illustrates the continued importance of examining the plausibility of allegations made in qui tam lawsuits by relators seeking enormous bounties under the federal False Claims Act.[1]

On behalf of the United States (which chose not to intervene), Integra sued a prominent Texas hospital system — Baylor Scott & White Health — that operates a network of inpatient short-term acute care hospitals and four affiliates.[2] Integra's qui tam suit claimed that the defendants systematically upcoded secondary...

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