Affinity Living Beats Attorney Whistleblower’s Medicaid Appeal

Adult care home operator Affinity Living Group LLC and others showed that a whistleblower failed to adequately allege that they violated the False Claims Act by over billing North Carolina Medicaid, the Fourth Circuit affirmed Thursday.

Whistleblower and attorney Stephen Gugenheim didn’t demonstrate that the defendants acted with requisite scienter when they submitted bills, Judge Allison Jones Rushing of the U.S. Court of Appeals for the Fourth Circuit said in a split decision.

The policy and related guidance from North Carolina Medicaid on how to bill for services are sufficiently ambiguous to foreclose the possibility of fraud, the majority said. ...