In the current research paper, I will discuss two legal cases in the healthcare industry. The first case concerns Medicare and Medicaid fraud, which has caused approximately $3.5 million in losses. Consequently, the second case regards the false claims, fraudulent schemes, and consequent permission for Motion for Leave to file additional complaints. Ultimately, both cases address the machinations and fraud schemes in the healthcare industry.
United States of America v. Emordi et al.
- No. 19-10400
- 959 F.3d 644 (2020)
Facts
In 2001, the two defendants – Okwilagwe and Isidaehomen – opened a home healthcare business, titled Elder Care Home Health Services, LLC. However, they exploited the name of their mutual friend – Gloria Ogabi – to sign various documents, listing Ogabi as the owner of the firm. In 2007, Ogabi asked Okwilagwe and Isidaehomen to exclude her from the organization. The defendants seemingly agreed to the proposal but did not fulfill their obligations. Consequently, in 2012, the Texas Department of Health and Human Services Office of Inspector General banned Okwilagwe and Emordi (the third defendant) from participating in all Federal healthcare programs. Nevertheless, Okwilagwe continued operating the company under the name of Ogabi. During the exclusion period, the organization received approximately $3.5 million from Medicare and Medicaid. Lastly, Adetutu Etti – the fourth defendant and the Nursing Director of the company – claimed that no excluded practitioners operated in the organization, which was a false statement.
Issue
The plaintiff claimed that the cause of action was healthcare fraud and false statements.
Rule
The rule of law was healthcare fraud violating 18 U.S.C.
§§ 1347 and 1349 (Count I) and false statements under 18 U.S.C. § 1035.
Analysis
The court proved that the defendants knowingly exploited the name of Gloria Ogabi, received financial support from Medicare despite the ban, and presented false statements to FBI agents and the court.
Conclusion
The court ruled that the plaintiff proved the economic damage caused by the healthcare fraud and found all defendants guilty.
United States of America and State of Indiana ex rel. Thomas P. Fischer v Community Health Network Inc. et al.
- No. 1:14-cv-01215-RLY-DLP
- S.D. Ind. (2020)
Facts: In the period from 2012 to 2015, Thomas P. Fischer – the Plaintiff-Relator of the case – had a prolonged conflict with Community Health Network (CHN). At the time, the plaintiff was a Chief Financial Officer of the organization and claimed that the monetary losses of the company were due to illegal activities. Namely, Thomas P. Fischer accused CHN guilty of healthcare fraud, false claims, and violation of applicable FCA anti-retaliation provisions and filed an original and, consequently, a First Amended Complaint. As a result, the allegations accounted for eight various breaches that the company should be accountable for. In 2019, the government initiated a Notice of Election to Intervene for some of the accusations and decided not to intervene in others. Namely, the government addressed the violations of the Stark Law and healthcare fraud. As a result, the Relator filed the Motion for Leave to File Second Amended Complaint in March 2020; however, CHN opposed this charge due to the futility of the amendments and unduly delay.
Issue
The plaintiff claimed that the Motion for Leave was justified and should be granted.
Rule
The rule of law was the permission to grant the application for leave as per Fed. R. Civ. P. 15(a).
Analysis
In the current case, the two primary objections from CHN are the futility of amendments and undue delay. The former is determined by the government intervention in part, statute of limitations, the FCA’s original source requirement. The latter concerns the six-year delay between the original complaint and the Motion for Leave. However, the court declared insufficient proof for these claims and dismissed the opposition.
Conclusion
The court ruled that the Motion for Leave to File Second Amended Complaint should be granted.
References
United States ex Rel. Fischer v. Community Health Network, Inc., no. 1: 14-cv-01215-RLY-DLP (S.D. Ind. Nov. 25, 2020).
United States v. Emordi, 959 F.3d 644 (5th Cir. 2020).