Integra Fca Appellate Opinions

Case summary

This page pairs two appellate decisions in False Claims Act qui tam suits by Integra Med Analytics over hospital Medicare coding, a matter outside the pandemic relief programs. In United States ex rel. Integra Med Analytics, L.L.C. v. Baylor Scott & White Health, No. 19-50818, an unpublished per curiam opinion of the Fifth Circuit filed May 28, 2020 (Chief Judge Owen and Judges Higginbotham and Willett) affirmed the Western District of Texas's dismissal in No. 5:17-CV-886 of a complaint alleging $61.8 million in fraudulent Medicare claims through secondary diagnosis codes, holding that the statistics were consistent with an obvious alternative explanation, that Baylor was ahead of other hospitals in following CMS coding guidelines, and that the specific claim examples were conclusory under Rules 8(a) and 9(b). In Integra Med Analytics LLC v. Providence Health & Services, No. 19-56367, a Ninth Circuit memorandum filed March 31, 2021 on interlocutory appeal from the Central District of California, No. 2:17-cv-01694-PSG-SS, reversed the partial denial of motions to dismiss by Providence and J.A. Thomas & Associates, Inc. and remanded with instructions to dismiss, for the same reason: the complaint did not eliminate the explanation that Providence was more effective at proper coding. The hosted record for each case is the appellate decision alone; neither district court docket is on the page.