AHA, CHAUSA say no to extrapolation in FCA cases

The AHA and Catholic Health Association of the United States today urged the U.S. Court of Appeals for the 4th Circuit to affirm a lower court ruling that relators seeking damages and penalties under the False Claims Act cannot use statistical sampling to prove a case challenging the exercise of medical judgment by a physician. “The FCA does not allow such shortcutting of proof that a claim was false,” the organizations state in a friend-of-court brief. “Because it is a fraud statute, FCA cases based on the exercise of a physician’s medical judgment about patient care can only result in treble damages and per-claim penalties if there is proof that the physician’s treatment decision was so unreasonable in light of the patient’s medical condition that it amounted to fraud on the United States. That showing cannot be made without actually reviewing and analyzing the documented medical history, diagnosis, and other information that the doctor relied upon in making treatment decisions for a particular patient.”