Goldberg v. Rush Univ. Med. Ctr. (Summary)

FALSE CLAIMS ACT

Goldberg v. Rush Univ. Med. Ctr., No. 04 C 4584 (N.D. Ill. Mar. 6, 2013)

The United States District Court for the Northern District of Illinois denied in part and granted in part motions to dismiss submitted by a medical center, a surgery center and a physician group, among others, all defendants in this False Claims Act (“FCA”) case.

The relators filed a qui tam action against the medical center, surgery center, a physician group and individual physicians for fraudulent claims billed to Medicare and Medicaid. The relators alleged that for nine years the defendants were billing for surgeries performed by residents who were improperly supervised or by surgeons performing overlapping surgeries, in violation of the Medicare and Medicaid rules and regulations.

The district court held that the relators alleged sufficient facts to survive the motion to dismiss against the surgery center and physician group. The court stated that each of the paragraphs in the complaint alleged specific instances of claims that were submitted to Medicare, and the fact that the relators did not have information on whether or not the claims were actually submitted was not relevant because that information was inaccessible to the relators. The district court also held that the relators’ complaint sufficiently alleged the “who, what, when, where, and why” necessary to allege fraud, since the relators specifically named certain physicians who engaged in the surgery scheme as well as detailed the fact that the surgery fraud was taking place in the medical center and the surgery center during the nine years indicated. The district court found that the details of the surgery schedules sufficiently demonstrated how the overlapping and unsupervised surgeries were being carried out.

The district court dismissed the medical center from the action, finding that the relators failed to allege that the medical center was knowingly submitting fraudulent claims, and the fact that the medical center allowed doctors to schedule concurrent surgeries was not a cause of action under the FCA.