Farnsworth v. HCA, Inc. – Sept. 2015 (Summary)

FRAUD AND ABUSE – FALSE CLAIMS ACT

Farnsworth v. HCA, Inc., No. 8:15-cv-65-T-24-MAP (M.D. Fla. Sept. 8, 2015)

The United States District Court for the Middle District of Florida granted in part and denied in part a hospital’s motion to dismiss claims made by a former employee under the False Claims Act. The employee was the Vice President of Quality and Risk Management, who had responsibilities that included the supervision of non-billing matters and employees.

The employee alleged that the hospital routinely billed Medicare and Medicaid for the treatment of certain patients, even though a teaching or attending physician was not physically present when the medical intern or resident performed the procedure. The employee also alleged that the hospital falsified medical records submitted to Medicare and Medicaid for procedures and services ordered by a suspended physician. Third, the employee alleged that the hospital double billed for unauthorized medical research, and that the hospital encouraged its staff to compile fraudulent reports to bill for unnecessary tests and treatments. Finally, the employee claimed that she was fired in retaliation for reporting the fraudulent billing practices to members of management.

The court granted the hospital’s motion to dismiss for the claims involving a third-party company, which was responsible for submitting Medicare and Medicaid bills. The claims against the company were dismissed because the employee did not allege sufficient facts regarding the company. The court denied the hospital’s motion to dismiss the claims made against it directly because the allegations were plausible and supported by appropriate factual detail.