Qui Tam Action-Standing

7^th Circuit Court of Appeals

Case Name: Judith Robinson v. Healthnet, Inc.

Case No.: 23-2728

Officials: Rovner, St. Eve, and Pryor, Circuit Judges.

Focus: Qui Tam Action-Standing

Dr. Robinson, a former employee of HealthNet, a federally qualified health center in Indiana, filed a qui tam lawsuit against HealthNet, accusing the organization of fraudulent billing practices, including improper Medicaid charges for ultrasound readings and billing for face-to-face encounters that never occurred. Dr. Robinson first initiated the case in 2013 (Robinson I), which was settled in 2017, excepting wrap-around claims, which were dismissed without prejudice.

In 2019, Dr. Robinson filed a second lawsuit (Robinson II) focused on the wrap-around claims. While the United States declined to intervene, Indiana chose to do so. Indiana sought to dismiss all claims except for the wrap-around claims from October 18, 2013, to February 28, 2015, arguing that the remaining claims were time-barred. The district court dismissed Count III of Dr. Robinson’s complaint, which sought to enforce an alleged oral settlement agreement, ruling that she lacked standing due to her failure to present sufficient evidence of the agreement’s existence.

The Seventh Circuit reviewed the case and upheld the district court’s decision. The court agreed that Dr. Robinson lacked standing, as she did not show any breach of the alleged oral agreement by HealthNet. The court also affirmed the district court’s approval of the settlement between Indiana and HealthNet, finding it fair, adequate, and reasonable. It noted that the reduction in the relator’s share resulted from Dr. Robinson’s own actions, including her failure to secure a tolling agreement, which led to the expiration of many claims. Lastly, the court concurred with the application of the Federal Medical Assistance Percentage (FMAP) in calculating the settlement amount.

Affirmed.

Decided 12/26/24

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