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Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders, Write Mary Inman and Max Voldman in RACMonitor

Posted  June 10, 2020

Constantine Cannon whistleblower attorneys Mary Inman and Max Voldman updated their earlier reporting in RAC Monitor regarding the False Claims Act case brought by Integra Med Analytics against Texas-based hospital chain Baylor Scott & White.  At the end of May, the Fifth Circuit Court of Appeals upheld a Texas district court opinion dismissing the case.

As we have earlier written, Integra alleged that the hospital defendant defrauded the Medicare program by overcharging for certain hospital visits.  Integra based its allegations on an analysis of publicly available hospital discharge data, which it used to identify certain patterns of diagnoses that Integra alleged arose from “upcoding” of diagnosis related groups (DRGs) that are the basis of Medicare payments to hospitals.

The Texas district court dismissed Integra’s lawsuit, holding that violated a provision of the FCA called “the public disclosure bar” which states that a whistleblower lawsuit cannot be based on information that is broadly, publicly available and that takes no specialized expertise to interpret. In upholding this decision, the Fifth Circuit pointed to Integra’s own legal filings, which demonstrated that non-Baylor hospitals were also following similar coding patterns, albeit later. The judges then surmised that Baylor was simply on the leading edge of this pattern, and that was not evidence of fraud.

A case brought by Integra against Providence Health System in California is currently on appeal before the Ninth Circuit Court of Appeals.  In addition, several other cases filed by Integra Med Analytics are in earlier stages of litigation, wending their way through various district courts throughout the U.S.

In addition to the article on RAC Monitor, Ms. Inman was also a featured guest on the site’s “Monitor Monday” podcast on June 8, 2020.  Listen to the episode here.

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Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud, Hospital Fraud, Medical Billing Fraud, Public Disclosure and Public Information, Upcoding, Whistleblower Eligibility,