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Whistleblower’s Medical Necessity Suit Revived by Ninth Circuit

March 23, 2020, 7:08 PM

Gardens Regional Hospital in California, management company S&W Health Management Services, and the company’s owner RollinsNelson LTC Corp. must again face a False Claims Act lawsuit accusing them of submitting claims to Medicare for medically unnecessary hospital admissions, the Ninth Circuit said.

Whistleblower Jane Winter may proceed with her suit because the False Claims Act doesn’t demand proving an objective falsity for a suit to prevail, the U.S. Court of Appeals for the Ninth Circuit said Monday.

A district court dismissed her claims, stating that a determination of medical necessity is a subjective opinion that can’t be medically false.

A ...