Melissa Jampol Quoted in “Mental Health False Claims Case Clears Appeals Court Hurdle”

Bloomberg BNA Health Care Daily Report

Melissa L. Jampol, a Member of the Firm in the Health Care and Life Sciences and Litigation practices, in the firm’s New York office, was quoted in the Bloomberg BNA Health Care Daily Report, in “Mental Health False Claims Case Clears Appeals Court Hurdle,” by Mary Anne Pazanowski. (Read the full version – subscription required.)

Following is an excerpt:

Fraud defense attorney Melissa L. Jampol agreed the decision wasn't surprising, given the facts pleaded by the whistle-blowers—known as relators in FCA parlance—were “so egregious.” The allegations included Universal's misrepresentations about staff members’ education, licenses and supervision. In some cases, the facility's staff members had fraudulently obtained National Practitioner Identifier numbers, the complaint said.

Jampol, a former assistant U.S. attorney, is a member of Epstein Becker & Green in New York.

The relators now can conduct discovery. “Moving forward, the question will be whether the evidence exists to sufficiently support the facts alleged by the relators of the materiality of the misrepresentations Universal submitted to MassHealth, the Massachusetts Medicaid program,” she said.

There is still another important issue the First Circuit didn't address, Jampol said. Namely, whether MassHealth knew Universal wasn't in compliance with the pertinent state regulations and paid claims anyway. The answer “may ultimately change the materiality calculus regarding the government's payment decisions if the case proceeds along to trial,” she said.

“The question of materiality of misrepresentations in connection with payment decisions in FCA cases still very much remains fact and circumstance dependent, relying on the unique circumstances of each case,” Jampol added. “For cases where there are not obvious misrepresentations and cases in gray areas, the issue of materiality is still very much up in the air.”