United States ex rel. Zafirov v. Florida Medical Associates LLC et al.

Docket No.
24-13581
Appellate Court
Eleventh Circuit

Goal

  • Award damages

Issues

Case History

Why This Matters:

Why This Matters

A physician filed a whistleblower lawsuit against her former employer and other provider organizations, alleging that the defendants violated the False Claims Act by submitting inaccurate, incomplete, unsupported, or otherwise false diagnosis codes for Medicare Advantage enrollees. The physician alleges that the defendants submitted this false information – otherwise known as upcoding – to improperly obtain millions of dollars in overpayments from the Medicare program. The Department of Justice intervened to defend the constitutionality of whistleblower lawsuits under the False Claims Act. The physician and the Department of Justice appealed a district court order dismissing the case after finding the whistleblower statute to be unconstitutional.

Potential Impact:

Potential Impact

Ensuring accurate claims for Medicare Advantage enrollees prevents fraud, protects taxpayer dollars, and keeps health care costs low for patients. The False Claims Act is the government’s primary tool to combat health care fraud, and whistleblower lawsuits play an especially important role in protecting patients and consumers by curbing unnecessary and harmful medical treatments, reducing wasteful spending, and deterring fraud to the tune of nearly 10 times the amount that is recovered.

27 Major Filings

View More

Related Litigation

Current Status

Briefing is ongoing

Legal Issues

False Claims Act - Submission of False or Fraudulent Claims, False Claims Act - False Certifications or Statements, False Claims Act - Overpayment

Date Filed
October 30, 2024
Case Type
Civil
Court Type
Appellate Court
Court
Eleventh Circuit
Plaintiff(s)
Clarissa Zafirov
Lead Counsel For Plaintiff(s)
Morgan Verkamp LLC
Intervenor Plaintiff(s)
United States
Amicus Briefs for Plaintiff(s)

Constitutional Accountability Center; The Leukemia & Lymphoma Society; Public Citizen; Randy Beck; American Association for Justice; Relators in Ongoing Relator-led Qui Tam Proceedings; Former Prosecutors; Legal History Scholars

Defendant(s)
Florida Medical Associates LLC; Physician Partners LLC; Physician Partners Specialty Services LLC (Dismissed); Sun Labs USA Inc. (Dismissed); Anion Technologies LLC; Anthem Inc. (Dismissed); Freedom Health Inc.; Optimum Healthcare Inc.; Siddhartha Pagidipati (Dismissed)
Lead Counsel for Defendant(s)
O'Melveny & Myers LLP
Amicus Briefs for Defendant(s)

Pacific Legal Foundation; Washington Legal Foundation; Pharmaceutical Researchers and Manufacturers of America; Former U.S. Attorneys General et al.; Center for Constitutional Responsibility