The U.S. Court of Appeals for the 9th Circuit yesterday stopped data analysis company Integra Med Analytics from proceeding with a False Claims Act lawsuit alleging Providence Health & Services used inflated codes to bill Medicare. Reversing the district court decision, the appeals court held that Integra “failed to state a plausible claim for relief because its allegations do not eliminate an obvious alternative explanation—that Providence, with [J.A. Thomas & Associates’] assistance, was more effective at properly coding for better Medicare reimbursement than others in the healthcare industry.” 

The AHA, California Hospital Association, and Washington State Hospital Association last year urged the U.S. Court of Appeals for the 9th Circuit to reverse the district court decision, which they said "gives private plaintiffs broad license to file suits under the False Claims Act in ways that Congress never intended and expressly barred." 
 

Related News Articles

Headline
A new study published in JAMA Internal Medicine is confirming the role Medicare plays in decreasing disparities in health care access and coverage in the…
News
Reps. Peter Welch, D-Vt., Suzan DelBene, D-Wash., Darin LaHood, R-Ill., and Brad Wenstrup, R-Ohio, yesterday reintroduced the Value in Health Care Act, AHA-…
News
The Centers for Medicare & Medicaid Services today advised clinicians in the Medicare Quality Payment Program who earned but did not receive an alternative…
Headline
Congress should not extend Medicare sequestration to help pay for the bipartisan infrastructure framework because health care providers cannot sustain…
Headline
The Centers for Medicare & Medicaid Services is accepting comments through Aug. 11 on whether to establish a national Medicare coverage policy for…
Headline
The AHA and other national hospital organizations today urged Senate leadership and senators supporting a bipartisan $1.2 trillion infrastructure agreement…