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October 21, 2022

Supreme Court Declines to Review Molina Healthcare False Claims Act Appeal

On October 17, the U.S. Supreme Court denied certiorari in Molina Healthcare of Il. et al., v. Prose, Thomas. This petition stemmed from a whistleblower case alleging that Molina Healthcare (Molina) submitted false claims to Illinois Medicaid for skilled nursing services thatit did not provide or contract for. The District Court had dismissed the case on the basis that the plaintiff’s complaint did not sufficiently allege that the skilled nursing services were material.  The Seventh Circuit reversed and remanded, holding that the large difference in Medicaid payments for nursing home patients vs. lower risk patients was sufficient to support the whistleblower’s claims. Molina raised two issues in its cert petition to the Supreme Court: “(1) Whether Federal Rule of Civil Procedure 9(b) requires plaintiffs in False Claims Act cases to plead details of the alleged false claims; and (2) whether a request for payment that makes no specific representations about the goods or services provided can be actionable under an implied false certification theory.” Following this denial of cert, the whistleblower suit will proceed in the District Court based on the generalized allegations.

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