Judge Frederic Block
Americare Inc., Americare Certified Special Services Inc. (Americare CSS) and Americare Therapy Services provide home health nursing services. Working for Americare CSS from 2002 to 2005, relator Mooney was responsible for reviewing its Medicare and Medicaid billings to ensure regulatory compliance. The court partly dismissed her qui tam actionasserting Medicare and Medicaid violations breaching the False Claims Act (FCA)alleging fraudulent kickbacks to third-parties in exchange for patient referrals, and a scheme involving alteration of documents to justify home health services. Although the alleged fraudulent alteration scheme satisfied the heightened pleading requirements of Federal Rule of Civil Procedure 9(b) with respect to Medicare claims, it did not do so on Medicaid claims. Nor did the fraudulent referral scheme satisfy Rule 9(b). Mooney did not particularly plead the "who, what, when, where and how" of the scheme. In finding that Mooney’s retaliatory discharge claims survived dismissal as against the three corporate defendants the court determined, among other things, that a reasonable jury could conclude that Mooney was investigating matters that were calculated or reasonably could lead to an FCA action.
