United States ex rel. Roy v. Anthony (S.D. Ohio, Cincinnati)
In this early health care fraud case, Ann Lugbill and her colleagues filed a ground-breaking False Claims Act complaint. The Roy medical kickback case alleged that the corporate structure and ownership of a sophisticated medical imaging business violated Medicare prohibitions against physicians receiving payments--termed kickbacks by Congress--as a result of the patient referrals they made to a business in which they had ownership interests. Despite the Department of Justice's failure to intervene, the Relator won a $2,010,000 recovery from the defendants.
Believed to be the first False Claims Act qui tam use of the kickback theory in attacking health care fraud, particularly one that was actively litigated and memorialized in a formal judicial opinion, Roy led the way. Since then, the Department of Justice has used and adopted the anti-kickback law reasoning in Roy in many dozens of False Claims Act health care fraud cases.
06/04/2014