Statistical Inferences can be Used to Establish Liability and Damages in Healthcare FCA Cases

For many years, the government and qui tam relators have employed various statistical models to estimate damages in Medicare fraud and other False Claims Act cases. It is now a well-established way to prove damages.

For example, in late 2014, a District Court in Tennessee ruled that extrapolation from a small sample of 400 claims can be used to establish FCA liability for a universe of over 150,000 claims. In that case, the defendant-skilled nursing home facility sought to compel discovery from the government for allegedly false claims outside of the government’s sample. The court rejected the defendant’s motion in a recent opinion, U.S. ex rel. Martin v. Life Care Centers of America, Inc., No. 08-cv-251 (E.D. Tenn. Feb. 18, 2015). The court stressed that allowing the defendant to conduct discovery as to claims outside of the government’s sample would require the very claim-by-claim review that the court previously determined to be unnecessary for establishing FCA liability.

More information for whistleblowers is located at the Nolan Auerbach & White website.