The Other Escobar

On this blog, I focus on what most of my clients have in common – the need for serious medical care and the attendant expenses. I often blog about Quality Fraud and share news items about how the cost of healthcare is driven by misrepresentations made in the course of providing care. Unlike other markets, healthcare consumers do not typically see their bills and have no ability to negotiate prices. As a consequence, the health market is opaque and ripe for predatory business practices.

This is the year anniversary of the United States Supreme Court opinion in Universal  Health v. Escobar, 136 S. Ct. 1989 (SC 2016). Referred to in shorthand as Escobar, the decision interprets the Federal False Claims Act  (31 USC Sec. 3729 et. seq.) that has its origin in the Civil War procurements of food, munitions and supplies by the United States Government for the military. In the context of health care, the Supreme Court in Escobar found that criminal and civil liability attaches where there is an “implied false certification” such as billing codes for services not performed or performed but in the presence of a statutory or other violation that is not disclosed. The Act is punitive in that it allows for treble damages and civil penalties for each false claim. Using the statute as interpreted, as reported on this blog, the Justice Department is regularly obtaining verdicts and settlements against healthcare providers in the billions of dollars.

In Escobar, a young woman receiving counseling had an adverse reaction to a medication prescribed by her clinic physician. Her lawyers sued the clinic on the theory that it billed Medicaid fraudulently for the services rendered in association with the prescription because the Clinic did not comply with the statutes and regulations requiring identification of the adverse event – which would have been material to payment. The District Court dismissal of the suit was overturned by the Supreme Court, creating remedies for consumers of healthcare services that might have been foreclosed before Escobar.

I learned how to read and analyze medical records and billings at an early age. I am competent at finding signs of chart alteration and billing fraud. With the help of appropriate experts, I have had success turning these leads into critical evidence. Make sure your lawyer understands medical charts before making a decision about who to hire to represent you for your serious injury.