In U.S. ex rel Guardiola v. Renown Health, et. al., Case No. 12-00295 (D. Nev.), a qui tam action alleging that Defendant submitted false claims for Medicare reimbursement, the District of Nevada considered whether to order Defendant to produce additional data to the relator (the individual who brought the qui tam action on behalf of the United States) so that the relator’s expert could conduct statistical sampling to identify the claims in question.
The court had already ordered that the parties could use statistical sampling to relieve them of having to examine every potential claim (a costly and time consuming exercise). After the relator’s expert examined the initial eDiscovery data produced by Defendant, the relator sought to alter the definition of “zero day stay” (intended to capture billing records for a less than 24 hours hospital stay) to account for a discrepancy in the two different billing systems Defendant used. The relator asserted that if Defendant did not expand the definition of “zero day stay,” the relator would not receive records for someone who everyone who had only been in the hospital for 23 hours because one of Defendant’s billing systems logged that as 26 hours.
Defendant objected to producing the additional data, but the magistrate judge agreed that it was relevant and ordered Defendant to produce it, and ordered that the relator could use the time-adjusted claims as part of her statistical sample. The court declined to rule on whether certain patient stays were factually zero-day stays for Medicare billing purposes, noting that this constituted an evidentiary issue outside the scope of the magistrate judge’s review.
ILS – Plaintiff Electronic Discovery Experts