Inactive Case

United States et al. ex rel. SW Challenger LLC. et al. v. Evicore Healthcare MSI LLC

Docket No.
22-530
Appellate Court
Second Circuit

Goal

  • Award damages
  • Block defendant action

Issues

Case History

Why This Matters:

Why This Matters:

Former employees filed a whistleblower lawsuit against a company that contracts with Medicare and Medicaid insurers to provide prior authorization and utilization management services. The former employees allege that the defendant violated the federal False Claims Act – as well as state laws in Alaska, California, Connecticut, Florida, Illinois, Michigan, New Jersey, New York, Louisiana, Montana, New Mexico, North Carolina, Oklahoma, Tennessee, Texas, and Washington – by auto-approving hundreds of requested medical procedures each day, including through the use of artificial intelligence. The former employees allege that the defendant did not perform the services that it was paid to perform by insurers  and, ultimately, by federal and state officials and thus submitted false or fraudulent claims for medical review services that never happened or that were not properly undertaken. On appeal, the former employees argued that the district court erred in dismissing the case for failure to state a claim.

Potential Impact:

Potential Impact:

Ensuring proper payment for Medicare and Medicaid organizations 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.

10 Major Filings

Related Litigation

Current Status

Decision issued

Legal Issues

False Claims Act - Submission of False or Fraudulent Claims, False Claims Act - False Certifications or Statements, False Claims Act - Overpayment, Alaska False Claims Act, California False Claims Act, Connecticut False Claims Act, Florida False Claims Act, Illinois False Claims Act, Louisiana State Law, Michigan False Claims Act, Montana False Claims Act, New Jersey False Claims Act, New Mexico False Claims Act, New York False Claims Act, North Carolina False Claims Act, Oklahoma False Claims Act, Tennessee False Claims Act, Texas State Law, Washington False Claims Act

Date Filed
March 14, 2022
Case Type
Civil
Court Type
Appellate Court
Court
Second Circuit
Judge
Sack, Robert D.; Carney, Susan L.; Bianco, Joseph F.
Plaintiff(s)
SW Challenger; Jane Doe 1 (Dismissed); Jane Doe 2 (Dismissed)
Lead Counsel For Plaintiff(s)
Seeger Weiss LLP
Defendant(s)
Evicore Healthcare MSI LLC
Lead Counsel for Defendant(s)
Mintz Levin Cohn Ferris Glovsky & Popeo P.C.
Other Party
State of Alaska (Non-Intervenor); State of California (Non-Intervenor); State of Connecticut (Non-Intervenor); State of Florida (Non-Intervenor); State of Illinois (Non-Intervenor); State of Louisiana (Non-Intervenor); State of Michigan (Non-Intervenor); State of Montana (Non-Intervenor); State of New Jersey (Non-Intervenor); State of New Mexico (Non-Intervenor); State of New York (Non-Intervenor); State of North Carolina (Non-Intervenor); State of Oklahoma (Non-Intervenor); State of Tennessee (Non-Intervenor); State of Texas (Non-Intervenor); State of Washington (Non-Intervenor)