U.S. ex rel. Jones v. Univ. of Utah Health Scis. Ctr. (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Jones v. Univ. of Utah Health Scis. Ctr., No. 2:11cv1200 (D. Utah Sept. 24, 2013)

The United States District Court for the District of Utah granted in part a hospital’s motion to dismiss, allowing the relator leave to amend the complaint to name as a defendant a state hospital employed physician in his individual capacity.

Parents of a patient brought a False Claims Act (“FCA”) claim against a state-run hospital after their daughter underwent three surgeries to repair her tendon and suffered postoperative complications. The parents alleged that the claims for their daughter’s surgeries were fraudulent because all of their daughter’s postoperative care was performed by a resident even though the surgical procedures (the fees for which included all post-operative care) were billed to Medicare and Medicaid under the guise of having been provided by the supervising physician.

The parents’ original complaint named as defendants the hospital and the supervising physician in his official capacity.  The court held that the claims against the hospital could not survive dismissal because they were state entities and, in turn, were not “persons” under the FCA.  Further, the supervising physician, while acting in his official capacity, would be standing in the state’s shoes and, in turn, could not be sued under the FCA.

However, the court went on to grant leave to the parents to amend their complaint to name as a defendant the supervising physician in his individual capacity. In doing so, the court rejected the physician’s argument that an FCA claim can only be maintained against a state actor who acts outside the scope of his official duties.  The court noted that allowing all state officials to the immune from suit under the FCA would be contrary to public policy.  Further, there is nothing in the FCA which provides an exception for state employees; the statute merely states that it applies to any person who submits a false claim or causes such a claim to be submitted.