Deficient Services Finding Can Be a Basis for a False Claims Suit

Deficient Services Finding Can Be A Basis For A False Claims Suit

In United States v. Houser and Houser, a 2011 federal criminal court case from Northern Georgia, the United States levied criminal false claim indictments against the Housers for billing for nursing home services that the government claimed were so “deficient” that to bill them constituted criminal fraud under 18 U.S.C. §1347.

The premise of the case was that the provided nursing home services were so deficient they amounted to “worthless” services. The government indicted the couple claiming that their billing for “worthless” services was tantamount to billing for services that were never provided, and billing of such to Medicare constituted an intent to defraud the Medicare program. (The nursing home deficiencies were well documented, but not remedied). The Housers were accused of failing to keep the program agreements, failing health and safety inspections/surveysfailing to pay vendors, and failing to pay taxes, and diversion of funds (the business was paying the ex-wife’s alimony, purchasing personal autos for the Housers, and purchasing real estate for the Housers).

The Housers moved to dismiss the indictment on the basis that the underlying statute violated the defendants’ constitutional rights, and that the statute was vague, such that the defendants had no adequate notice their actions could be criminal.

The district court undertook an analysis of the statutory language in the false claims statute, and determined that there was (1) no constitutional right violation based on an ex post facto (after the fact) analysis, and (2) no due process violation under the 5th Amendment.

Further, the court reviewed the statute under the vagueness claim of defendants, and found the statute had sufficient definiteness that ordinary persons could understand what conduct is prohibited.

The defendants’ motion to dismiss was denied and the case proceeded to trial.

The agencies that govern Medicare and the exclusion of individuals under the program consider a plea agreement, deferred adjudication, or settlement a “conviction” that will expose one to potential exclusion from the program.

If you need assistance understanding Medicare laws and regulations, consult our experienced Dallas healthcare lawyers for guidance.

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