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

Docket No.
8:19-cv-01236
District Court
Florida Middle

Goal

  • Award damages

Issues

Why This Matters:

Why This Matters:

A whistleblower filed a lawsuit against providers and Medicare Advantage 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 whistleblower 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.

Potential Impact:

Potential Impact:

Ensuring accurate compensation for Medicare Advantage 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.

81 Major Filings

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Related Litigation

Current Status

Appeal Filed

Legal Issues

False Claims Act

Date Filed
May 20, 2019
Case Type
Civil
Court Type
District Court
Court
Florida Middle
Judge
Mizelle, Kathryn K. Appointed By: Donald Trump
Plaintiff(s)
Clarissa Zafirov
Lead Counsel For Plaintiff(s)
Morgan Verkamp LLC
Intervenor Plaintiff(s)
United States
Amicus Briefs for Plaintiff(s)

Anti-Fraud Coalition

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)

U.S. Chamber of Commerce