Intermountain Healthcare Seeks to Dismantle the DOJ’s Chief Civil Fraud Enforcement Tool

Lawsuits initiated by whistleblowers under the False Claims Act.

Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most effective laws for prosecuting Medicare fraud. 

Specifically, Intermountain targeted the False Claims Act’s qui tam provisions, which allow private citizens (known as whistleblowers, or qui tam relators) to launch a lawsuit in the government’s name when they have information that individuals and/or companies are submitting (or causing to be submitted) false claims to the U.S. government and its various federal agencies, including the Centers for Medicare & Medicaid Services (CMS). If the lawsuit is successful, the whistleblower is entitled to receive a share of the government’s recovery as a reward for coming forward. 

In the present case, Dr. Gerald Polukoff, MD filed a whistleblower suit against Intermountain and another hospital for allegedly helping a staff cardiologist perform unnecessary heart surgeries on Medicare patients. In defending against the case, Intermountain now contends that the whistleblower provisions of the FCA violate the U.S. Constitution’s Appointments Clause, which provides that certain public officials must be appointed by the U.S. government. Per Intermountain’s argument, whistleblowers who file FCA cases in the government’s name alleging fraud against the government are acting as officers of the U.S. without having been properly appointed.               

The odds of the Supreme Court granting Intermountain’s petition here are quite long. The four federal circuit courts of appeal to have considered the issue, including the 10th Circuit Court of Appeals, which heard the Intermountain case, have all rejected arguments that the whistleblower provisions are unconstitutional under the Appointments Clause. What’s more, the Supreme Court has already held in its 2000 ruling Vermont Agency of Natural Resources v. Stevens, penned by the late Justice Antonin Scalia, that False Claims Act whistleblowers have legal standing to bring cases on the government’s behalf.   

What really gave this story its legs, however, is the fact that the individual who originally championed the argument that the FCA’s whistleblower provisions violate the Constitution’s Appointments Clause is none other than the current nominee for U.S. Attorney General, William Barr. Mr. Barr has been an outspoken critic of the whistleblower provisions of the False Claims Act, even after the provisions were upheld by the Supreme Court’s ruling in Stevens, and has famously called them “an abomination.” During his Senate confirmation hearings last week, Barr was asked by U.S. Sen. Chuck Grassley, a strong advocate for whistleblowers, if he renounced his previous criticisms. Barr affirmed that he would diligently enforce the False Claims Act, and that it is not an “abomination.”     

Although the chances may be slim that the Supreme Court will grant Intermountain’s petition, in light of the above obstacles, the stakes are always extraordinarily high when it comes to False Claims Act whistleblowers. Of the $60 billion that has been returned to the U.S. Treasury via successful False Claims Act lawsuits to date, 85 percent of this amount (or $51 billion) is attributable to qui tam lawsuits initiated by whistleblowers.

Our eyes, like many others, remain fixed on the Supreme Court as it reviews Intermountain’s certiorari petition and decides whether to consider anew the constitutionality of whistleblower lawsuits.

We will continue to track this case as it unfolds. 

Program Note:

Listen to Mary Inman on Monitor Monday, Jan. 28, 10-10:30 a.m. EST.

 

Comment on this article

Facebook
Twitter
LinkedIn

Mary Inman, Esq.

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs. Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients. Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. Mary is a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

Related Stories

You Down with CfC?

You Down with CfC?

Anyone who has worked within the scope of hospital case/utilization management for any period of time has heard of the Centers for Medicare & Medicaid

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 25, 2025
Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.

September 24, 2025

Trending News

Featured Webcasts

Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025
E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.

August 26, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24