The district court had held that compliance with the AKS was not a condition for payment from the government under the federal health insurance program and that Wilkins and Willis didn’t have a claim for relief under the False Claims Act.
According to the facts and procedural history included in the ruling, Wilkins and Willis began working with UnitedHealth Group and AmeriChoice in 2007, Willis as a general manager for Medicare/Medicaid marketing and sales and Wilkins as a sales representative. In 2008, UnitedHealth terminated Wilkins' employment and demoted and then terminated Willis, allegedly for their complaints about what they perceived as illegal practices.
Among the allegations in the suit, which was filed in 2008, is that AmeriChoice's sales representatives paid $27,000 to Reliance Medical Group to switch certain eligible beneficiaries to its Medicare and Medicaid plans and that United Health's sales representatives offered payments to physicians in exchange for the physicians providing the names of potential new enrollees eligible for Medicare and Medicaid.
In remanding the anti-kickback portion of the suit the Third Circuit Court of Appeals noted “compliance with the AKS is clearly a condition of payment under Parts C and D of Medicare and appellees (UHG and AmeriChoice-New Jersey) do not refer us to any judicial precedent holding otherwise.” The ruling also stated that Walkins and Willis “ by alleging that appellees violated the AKS while submitting claims for payment to a federal health insurance program, have stated a plausible claim for relief under the FCA.”
UnitedHealth Group has not issued a statement on the case.