U.S. ex rel. Wall v. Vista Hospice Care, Inc. — June 2016 (Summary)

QUI TAM/FALSE CLAIMS ACT

U.S. ex rel. Wall v. Vista Hospice Care, Inc.
No. 3:07-cv-00604-M (N.D. Tex. June 20, 2016)

The U.S. District Court for the Northern District of Texas granted summary judgment for a hospice as to its alleged violations of the False Claims Act (“FCA”) and the Anti-Kickback statute (“AKS”).  However, the claim of retaliation by the individual who brought the lawsuit, called the “relator,” and who was a former social worker for the hospice, survived summary judgment.

The relator claimed that the provider violated the FCA by admitting and maintaining ineligible patients on Medicare.  The court determined that it could not conclude from the evidence that the hospice enrolled and maintained ineligible patients.

The relator also claimed that the hospice offered to pay employees bonuses for hitting admissions targets, an AKS violation. The hospice argued, and the court agreed, that this conduct was protected by the bona fide employee exception of the AKS, and granted summary judgment for the hospice on this claim.  Even if the bonuses had been a violation of the AKS, the court stated that the relator had not met the other elements to prove an FCA claim.

The court denied summary judgment for the hospice as to the relator’s claim of retaliation.  Because the relator had provided evidence of her positive performance reviews before raising concerns and that she was fired within months of doing so, the court held that there was sufficient evidence to connect the relator’s protected activity and her termination.