Expert testimony not required in off-label False Claims Act case, 7th Circuit concludes

by Ben Vernia | September 9th, 2013

Reversing a district court’s grant of summary judgment on August 28 in U.S. ex rel. Watson v. King-Vassel, the Court of Appeals for the Seventh Circuit held that the whistleblower in the declined qui tam was not required to present expert testimony in support of his claims. The relator alleged that the defendant, a psychiatrist who had treated a minor, caused the submission of false claims to the Wisconsin’s Medicaid program when she prescribed drugs off-label.

In its opinion, the Court of Appeals concluded that expert testimony was unnecessary to establish:

  • The defendant physician’s state of mind;
  • The causal link between the prescription and the claim to Medicaid; or
  • The interpretation of pharmaceutical compendia on which Medicaid reimbursement depended.

The Court agreed with the district court, however, that the relator’s conduct in procuring the minor’s medical records (he had obtained an authorization from a parent and presented it to the defendant, claiming that he needed the records to provide treatment) was unconscionable and that sanctions for it were warranted.

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