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ARTICLE · 14 SEPTEMBER 2021

Seventh Circuit Revives FCA Suit Despite Disagreeing On Materiality

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The case arose from Molina's provision of Medicaid services to Illinois residents under a capitation contract, whereby Illinois paid Molina a fixed fee for each of its enrollees.

United StatesLitigation, Mediation & Arbitration
Elliot S. Rosenwald
Elliot S. Rosenwald
Jennifer Oh
Jennifer Oh
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In United States ex rel. Prose v. Molina Healthcare of Illinois, Inc., No. 20-2243 (7th Cir. Aug. 19, 2021), a split panel of the Seventh Circuit reversed the district court's dismissal of a False Claims Act suit accusing Molina of submitting fraudulent claims to Illinois' Medicaid program for services it allegedly did not provide. In particular, the Seventh Circuit reversed the district court's holding that Molina did not know that certain healthcare services it allegedly failed to provide played "a material role in the delivery of Medicaid benefits." This holding prompted a strong dissent from one member of the panel, making this case an interesting discussion of the strict materiality requirement described in Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016).

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