Anything involving financial transactions has to be handled carefully. One reason for that is so all parties involved are satisfied and don’t have any regrets. Another reason is because there are many laws in Texas that govern financial transactions. Running afoul of those laws can result in being accused of fraud by angry people who feel that they were done wrong and having to defend against those accusations in court. Of course, some people who are accused of fraud win in court. One of the ways to win is by getting the case dismissed.
That happened in a recent case, when a lawsuit filed under the False Claims Act was dismissed by a Texas federal judge. The whistleblower lawsuit had been filed two years ago. Often, cases like this can take a long time to work their way through the system on the way to their final resolution.
The lawsuit alleged that a Texas-based health company committed fraud by over-billing Medicare across seven years. According to the allegations of the lawsuit, the company had submitted over 461.8 million worth of false claims to Medicare. The mechanism for the false claims was said to be putting down specific diagnosis codes on claims.
However, the judge disagreed. He said that there was nothing unethical or inappropriate with the diagnosis codes that were on the claims, and that the codes used were supported by medical documentation. The judge also said that the whistleblower did not state a claim for relief in a proper manner. Apparently, the claim for relief did not allege that the company had knowingly used incorrect codes. Such an allegation would have been necessary for the case to proceed. This case shows that allegations of fraud, if believed to be unfounded, are worth fighting.