Fifth Circuit Tosses Whistleblower Lawsuit Against Mississippi Health Plan Alleging Medicaid Fraud
- April 17, 2020
The Fifth Circuit affirmed the dismissal with prejudice of a qui tam action alleging a health plan that contracts with the Mississippi Medicaid program violated the False Claims Act (FCA) by using licensed practical nurses for case and care management services that should have been staffed by registered nurses.
The appeals court agreed with the lower court that relator Gwendolyn Porter, a licensed registered nurse, who formerly worked for defendant Magnolia Health Plan Inc., failed to show that the staffing issue was material to the plan's contracts with the state.
The Mississippi Medicaid program contracted with Magnolia to provide a “comprehensive package” of services on par with current Medicaid benefits. Magnolia also was contracted to provide care and case management services.
Porter alleged that while working for Magnolia from February 2011 through September 2012, she discovered that licensed practical nurses were serving as case and care managers instead of registered nurses.
The district court dismissed the action, finding Porter failed to identify specific contractual provisions requiring case and care managers to be registered nurses, to identify any specific federal or state statute requiring registered nurses to provide these services, and to establish that the staffing issue was a material term of the contract.
In an unpublished decision, the Fifth Circuit affirmed.
Even assuming Mississippi statutes and regulations required specific staffing of case and care manager positions, broad boilerplate language to adhere to all laws in Magnolia’s contracts with the state wasn’t enough to establish FCA liability, the Fifth Circuit said.
The appeals court also noted that the state continued to pay and renew contracts with Magnolia after Porter informed officials about the staffing issue.
The appeals court agreed with the lower court that it would be futile for Porter to amend her complaint since there was no reasonable basis for her to recover.
Porter v. Magnolia Health Plan, Inc., No. 18-60746 (5th Cir. Apr. 15, 2020).