U.S. ex rel. Schramm v. Fox Valley Physical Servs. — Feb. 2016 (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Schramm v. Fox Valley Physical Servs.
No. 12C8262 (N.D. Ill. Feb. 11, 2016)

The United States District Court for the Northern District of Illinois denied a motion to dismiss allegations of violations of the False Claims Act (“FCA”), payment under mistake of fact, and unjust enrichment against various defendants.

A physician’s assistant was employed by a health care entity. She alleged facts against the entity, including that she was not given her own password to log into the electronic medical record system to enter Medicare bills. She was told to log in using a physician’s login identification and enter information falsely under the physician’s name so that the service would be billed at the physician rate instead of the physician assistant rate of billing. She also alleged that slips of paper were used to record patient treatment records instead of entering the information directly into patient files. This was done so that the services could be billed under a different individual’s name who was CMS authorized so that the provider could receive payment from CMS. She also claimed that bills were made for services that were never rendered. The court held that her amended complaint described above contained sufficient information and that the “who, what, when, and how” were explicitly described and therefore the motion to dismiss was denied.