Florida judge upholds qui tam suit against particularity challenge

by Ben Vernia | March 4th, 2013

On February 19, Middle District of Florida Judge John Antoon II, writing in U.S. ex rel. Dittman v. Adventist Health System/Sunbelt, Inc., denied the defendant hospital’s motion to dismiss on Fed. R. Civ. P. 9(b). The hospital argued that a new count the relator added after the court denied a previous motion to dismiss was barred because of lack of particularity.

Judge Antoon noted that in his previous order, he had found that the relators – a former coding professional and a former physician with staff privileges – had “set forth a factual basis for their personal knowledge of the events at issue [(the alleged improper use of billing code modifiers, the use of incorrect price file numbers, and false billing for software analysis of mammograms)], and this provides the required ‘indicia of reliability’ of their allegations.”

Although the relator’s new allegations concerned improper claims for emergency department services, Judge Antoon once again found that one relator – the former billing specialist – had sufficiently alleged her personal knowledge by virtue of her time in the hospital’s Revenue Management Department, thereby satisfying the “indicia of reliability” standard in the 11th Circuit.

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