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United States of America, On the Relation of Kelly Baltazar v. Lillian S. Warden and Advanced Healthcare Associates, S.C

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ARGUED OCTOBER 27, 2010

Before EASTERBROOK, Chief Judge, and KANNE and WOOD, Circuit Judges.

In this qui tam proceeding under the False Claims Act, 31 U.S.C. §§ 3729–33, Kelly Baltazar contends that her former employer submitted fraudulent bills to the Medicare and Medicaid programs. Baltazar, a chiropractor, worked for four months in 2007 at Advanced Healthcare Associates. According to Baltazar’s complaint, she noticed that the firm’s staff added to her billing slips services that had not been rendered and changed the codes for services that had been performed. (This latter practice, designed to depict the procedure as one that fetches higher reimbursement, goes by the name “upcoding.”) After doing a little digging, Baltazar concluded that this was normal practice at the firm and that a substantial fraction of all bills submitted to the federal government had been fraudulently inflated on the instructions of Lillian Warden, the firm’s owner. Baltazar quit and filed this suit.

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