Earlier this year in Winter v. Gardens Regional Hospital, the 9th Circuit Court of Appeals revived a False Claims Act case filed by the Director of Care Management in a California hospital that claimed nearly $1.3 in Medicare claims that sought reimbursement for inpatient hospitalizations that were not medically necessary.
The U.S. District Court of Utah dismissed the case, without leave to amend, for failing to state a claim under the FCA. Specifically, the court believed that the qui tam plaintiff’s complaint failed to state a cause of action under the FCA because the allegations as a matter of law were “subjective medical opinions” that demonstrated a mere “difference of opinion” as to the medical necessity of inpatient hospital admissions.