United States First Circuit

In this False Claims Act case, relators allege that their daughter, who died of a seizure in 2009, was treated by various unlicensed and unsupervised staff employed by defendant, in violation of Massachusetts state regulations. Relators contend that defendant's noncompliance with sundry supervision and licensure requirements rendered its reimbursement claims submitted to the state Medicaid agency actionably false under both the federal and Massachusetts False Claims Acts. The district court's dismissal of the complaint is reversed and remanded, except for the portion of the complaint pertaining to the employment of psychologists, where: 1) a healthcare provider's noncompliance with conditions of payment is sufficient to establish the falsity of a claim for reimbursement; 2) relators' daughter died after receiving treatment that was out of compliance with over a dozen regulations, and relators have carefully compiled information regarding the allegedly false claims submitted to MassHealth; and 3) therefore, relators have appropriately stated a claim with particularity under the False Claims Act.

Appellate Information

• Decided 03/17/2015
• Published 03/17/2015

Judges

• Stahl

Court

• United States First Circuit

Counsel