U.S. ex rel. Schubert v. All Children’s Health Sys. (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Schubert v. All Children’s Health Sys., No. 8:11-cv-1687-T-27EAJ (M.D. Fla. Apr. 16, 2013)

The United States District Court for the Middle District of Florida granted a motion for summary judgment in favor of a health system in this False Claims Act case regarding the overcompensation of physicians.  The qui tam relator alleged that the health system over-compensated physicians by not following its physician group’s compensation plan, under which compensation was not to exceed the 75^th percentile of the national average for physician salaries.  The court noted that a False Claims Act claim must allege more than labels and conclusions – it must also state with particularity the circumstances constituting fraud.

The relator did not dispute that she could not identify a single false claim, but instead argued that each claim submitted by the health system was contrary to Stark and the Anti-Kickback Statute since the health system falsely certified that its claims complied with all applicable laws and regulations.  The court found that although this “implied certification” theory was viable, the relator was still required to plead her case with particularity.  The court held that she did not meet this burden because she did not identify the specific false claims, did not allege the kickbacks, referrals or false certifications with particularity, did not provide patients, dates, referrals, procedures or bills relating to false claims, and did not describe any false certifications.  The court also found that these deficiencies could be excused if the court can infer “indicia of reliability” from a relator’s position, but in this case the relator did not even work in the relevant department or with the same company that was alleged to have presented false claims.