Latest Case This Week: Winter v. Gardens Regional Hospital & Medical Center, Inc. (9th Cir.)

Whence Cometh Evil? Making Sense of Human Suffering and COVID-19

CHARLES E. BINKLEY

Surgeon and bioethicist Charles E. Binkley, MD, offers a perspective on how we might make sense of suffering, particularly in light of the present COVID-19 pandemic. Binkley suggests that through suffering, we are paradoxically able to find good, and in this instance, that good might be the practice of social reciprocity.

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Winter v. Gardens Regional Hospital & Medical Center, Inc.

Court: US Court of Appeals for the Ninth Circuit

Docket: 18-55020

Opinion Date: March 23, 2020

Judge: Bennett

Areas of Law: Government Contracts, Health Law

The Ninth Circuit reversed the district court's dismissal of a qui tam action brought by relator under the False Claims Act, alleging that defendants submitted, or caused to be submitted, Medicare claims falsely certifying that patients' inpatient hospitalizations were medically necessary. After determining that it had jurisdiction, the panel held that a plaintiff need not allege falsity beyond the requirements adopted by Congress in the FCA, which primarily punishes those who submit, conspire to submit, or aid in the submission of false or fraudulent claims. The panel wrote that Congress imposed no requirement of proving "objective falsity," and the panel had no authority to rewrite the statute to add such a requirement. The panel held that a doctor’s clinical opinion must be judged under the same standard as any other representation. The panel explained that a doctor, like anyone else, can express an opinion that he knows to be false, or that he makes in reckless disregard of its truth or falsity. Therefore, a false certification of medical necessity can give rise to FCA liability. The panel also held that a false certification of medical necessity can be material because medical necessity is a statutory prerequisite to Medicare reimbursement.