Justia U.S. 1st Circuit Court of Appeals Opinion Summaries

An inmate of the Maine corrections system, sought a civil rights remedy (42 U.S.C. 1983) for alleged denial of adequate medical care for human immunodeficiency virus (HIV) by healthcare professionals at a jail and the state prison. The district court entered summary judgment for the defendants. The First Circuit affirmed with respect to the contractor that provides care, stating that the evidence could not establish Eighth Amendment violations, but reversed with respect to a physicians' assistant. Although the contractor acknowledged that its care "fell short of the mark," carelessness or inadvertence falls short of the Eighth Amendment standard of deliberate indifference. There was a material dispute about deliberate indifference by the physicians' assistant, who had a financial interest in limiting care and a disciplinary history.

Plaintiff brought action under the False Claims Act, 31 U.S.C. 3729, claiming that the company used a kickback scheme and knowingly caused submission of false Medicare, Medicaid, and TRICARE claims by hospitals and doctors. The district court held that hospital claims at issue were not false or fraudulent, and that doctor claims were false or fraudulent, but not materially so. The First Circuit reversed. If kickbacks affected the transactions underlying the claims, the claims failed to meet a condition of payment and were false, regardless of the hospital's participation in or knowledge of the kickbacks. It cannot be said, as a matter of law, that the alleged misrepresentations were not capable of influencing Medicare's decision to pay the claims.