False Claims Act Pleading Special Matters.

• Author: Hawkins, Derek
• Position: John Mamalakis v. Anesthetix Management

Byline: Derek Hawkins

7th Circuit Court of Appeals

Case Name: United States of America ex rel. John Mamalakis v. Anesthetix Management, et al.,

Case No.: 19-3117

Officials: SYKES, Chief Judge, and HAMILTON and ST. EVE, Circuit Judges.

Focus: False Claims Act Pleading Special Matters

Dr. John Mamalakis, a Wisconsin anesthesiologist, filed this qui tam lawsuit under the False Claims Act, 31 U.S.C. 3729 et seq., alleging that Anesthetix Management LLC, his former employer, fraudulently billed Medicare and Medicaid for services performed by its anesthesiologists. His central allegation is that the anesthesiologists regularly billed the government using the code for "medically directed" services when their services qualified for payment only at the lower rate for services that are "medically supervised." A magistrate judge dismissed the case, ruling that the complaint did not provide enough factual particularity to satisfy Rule 9(b)'s heightened pleading standard for fraud claims. FED. R. CIV. P. 9(b). The judge gave Mamalakis a chance to amend, directing him to provide representative examples of the alleged fraudulent billing.

Mamalakis obliged, filing an amended complaint that included ten specific examples of inflated billing. Each example identified a particular procedure and anesthesiologist and provided details about how the services did not qualify for payment at the...