Intermountain Healthcare Seeks to Dismantle the DOJ’s Chief Civil Fraud Enforcement Tool

Lawsuits initiated by whistleblowers under the False Claims Act.

Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most effective laws for prosecuting Medicare fraud. 

Specifically, Intermountain targeted the False Claims Act’s qui tam provisions, which allow private citizens (known as whistleblowers, or qui tam relators) to launch a lawsuit in the government’s name when they have information that individuals and/or companies are submitting (or causing to be submitted) false claims to the U.S. government and its various federal agencies, including the Centers for Medicare & Medicaid Services (CMS). If the lawsuit is successful, the whistleblower is entitled to receive a share of the government’s recovery as a reward for coming forward. 

In the present case, Dr. Gerald Polukoff, MD filed a whistleblower suit against Intermountain and another hospital for allegedly helping a staff cardiologist perform unnecessary heart surgeries on Medicare patients. In defending against the case, Intermountain now contends that the whistleblower provisions of the FCA violate the U.S. Constitution’s Appointments Clause, which provides that certain public officials must be appointed by the U.S. government. Per Intermountain’s argument, whistleblowers who file FCA cases in the government’s name alleging fraud against the government are acting as officers of the U.S. without having been properly appointed.               

The odds of the Supreme Court granting Intermountain’s petition here are quite long. The four federal circuit courts of appeal to have considered the issue, including the 10th Circuit Court of Appeals, which heard the Intermountain case, have all rejected arguments that the whistleblower provisions are unconstitutional under the Appointments Clause. What’s more, the Supreme Court has already held in its 2000 ruling Vermont Agency of Natural Resources v. Stevens, penned by the late Justice Antonin Scalia, that False Claims Act whistleblowers have legal standing to bring cases on the government’s behalf.   

What really gave this story its legs, however, is the fact that the individual who originally championed the argument that the FCA’s whistleblower provisions violate the Constitution’s Appointments Clause is none other than the current nominee for U.S. Attorney General, William Barr. Mr. Barr has been an outspoken critic of the whistleblower provisions of the False Claims Act, even after the provisions were upheld by the Supreme Court’s ruling in Stevens, and has famously called them “an abomination.” During his Senate confirmation hearings last week, Barr was asked by U.S. Sen. Chuck Grassley, a strong advocate for whistleblowers, if he renounced his previous criticisms. Barr affirmed that he would diligently enforce the False Claims Act, and that it is not an “abomination.”     

Although the chances may be slim that the Supreme Court will grant Intermountain’s petition, in light of the above obstacles, the stakes are always extraordinarily high when it comes to False Claims Act whistleblowers. Of the $60 billion that has been returned to the U.S. Treasury via successful False Claims Act lawsuits to date, 85 percent of this amount (or $51 billion) is attributable to qui tam lawsuits initiated by whistleblowers.

Our eyes, like many others, remain fixed on the Supreme Court as it reviews Intermountain’s certiorari petition and decides whether to consider anew the constitutionality of whistleblower lawsuits.

We will continue to track this case as it unfolds. 

Program Note:

Listen to Mary Inman on Monitor Monday, Jan. 28, 10-10:30 a.m. EST.

 

Comment on this article

Facebook
Twitter
LinkedIn

Mary Inman, Esq.

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs. Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients. Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. Mary is a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Trending News

Featured Webcasts

Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24