U.S. ex rel. Upton v. Family Health Network, Inc. (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Upton v. Family Health Network, Inc., No. 09 C 6022 (N.D. Ill. Mar. 4, 2013)

In this False Claims Act (“FCA”) case, the United States District Court for the Southern District of Illinois denied a managed care organization’s (“MCO”) motion to dismiss the federal and state FCA claims against it.

The MCO contracted with the state and federal governments, agreeing not to discriminate based on health status, and certified quarterly that it would not participate in such discrimination. However, the relator alleged that the MCO routinely submitted claims to Medicare and Medicaid, while discriminating based on health status by refusing to enroll high-cost individuals.

The court found that the relator had stated FCA claims against the MCO and denied its motion to dismiss.