Providence Health Gets Medicare Fraud Case Tossed (Correct)

April 1, 2021, 6:24 PM; Updated: April 2, 2021, 8:05 PM

A False Claims Act lawsuit against Providence Health & Services and J.A. Thomas & Associates Inc. must be dismissed because the whistleblower didn’t adequately allege the defendants improperly billed Medicare for “more lucrative” diagnoses than were necessary, the Ninth Circuit said.

Integra Med Analytics LLC didn’t show that a fraud scheme was the reason the defendants submitted Medicare claims with higher reimbursement rates than most other comparable institutions, the U.S. Court of Appeals for the Ninth Circuit ruled in a unpublished decision issued Wednesday.

Integra Med’s lawsuit ignores an “obvious alternative explanation” that the defendants were more effective at properly...

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