Quimbee logo
DMCA.com Protection Status

Kane ex rel. United States v. Healthfirst, Inc.

120 F. Supp. 3d 370 (2015)

Case BriefRelatedOptions
From our private database of 35,600+ case briefs...

Kane ex rel. United States v. Healthfirst, Inc.

United States District Court for the Southern District of New York

120 F. Supp. 3d 370 (2015)

Facts

In 2005, the New York State Department of Health (DOH) contracted with Healthfirst (defendant) to provide services to Medicaid-eligible individuals for a flat monthly payment. Healthfirst operated by paying healthcare providers in exchange for performing services, with the understanding that the providers could not seek additional payment from Medicaid. However, an error in the electronic system Healthfirst used to pay its providers led to providers believing that they could submit claims to both Healthfirst and Medicaid. In 2010, government officials noticed the incorrect Medicaid billing and met with Continuum Health Partners, Inc. (defendant), which operated several hospitals within Healthfirst’s network. Following the meeting, the electronic glitch was discovered, and Continuum tasked an employee, Robert P. Kane (plaintiff) with reviewing all claims that had been affected. Five months later, Kane provided Continuum with a list of more than 900 claims that he believed Medicaid had mistakenly paid. Four days later, Kane was terminated, and Continuum did no further investigation. Kane filed a qui tam action under the False Claims Act (FCA) and a similar state statute, which the United States government and New York government (plaintiffs) intervened. Healthfirst moved to dismiss the government’s intervention on the ground that the government did not comply with Federal Rule of Civil Procedure 9(b) because the government had not properly pleaded that Healthfirst had an obligation of payment.

Rule of Law

Issue

Holding and Reasoning (Ramos, J.)

What to do next…

  1. Unlock this case brief with a free (no-commitment) trial membership of Quimbee.

    You’ll be in good company: Quimbee is one of the most widely used and trusted sites for law students, serving more than 618,000 law students since 2011. Some law schools—such as Yale, Berkeley, and Northwestern—even subscribe directly to Quimbee for all their law students.

    Unlock this case briefRead our student testimonials
  2. Learn more about Quimbee’s unique (and proven) approach to achieving great grades at law school.

    Quimbee is a company hell-bent on one thing: helping you get an “A” in every course you take in law school, so you can graduate at the top of your class and get a high-paying law job. We’re not just a study aid for law students; we’re the study aid for law students.

    Learn about our approachRead more about Quimbee

Here's why 618,000 law students have relied on our case briefs:

  • Written by law professors and practitioners, not other law students. 35,600 briefs, keyed to 984 casebooks. Top-notch customer support.
  • The right amount of information, includes the facts, issues, rule of law, holding and reasoning, and any concurrences and dissents.
  • Access in your classes, works on your mobile and tablet. Massive library of related video lessons and high quality multiple-choice questions.
  • Easy to use, uniform format for every case brief. Written in plain English, not in legalese. Our briefs summarize and simplify; they don’t just repeat the court’s language.

Access this case brief for FREE

With a 7-day free trial membership
Here's why 618,000 law students have relied on our case briefs:
  • Reliable - written by law professors and practitioners, not other law students
  • The right length and amount of information - includes the facts, issue, rule of law, holding and reasoning, and any concurrences and dissents
  • Access in your class - works on your mobile and tablet
  • 35,600 briefs - keyed to 984 casebooks
  • Uniform format for every case brief
  • Written in plain English - not in legalese and not just repeating the court's language
  • Massive library of related video lessons - and practice questions
  • Top-notch customer support

Access this case brief for FREE

With a 7-day free trial membership