U.S. ex rel. Keltner v. Lakeshore Med. Clinic, Ltd. (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Keltner v. Lakeshore Med. Clinic, Ltd., No. 11-CV-00892 (E.D. Wis. Mar. 28, 2013)

The United States District Court for the Eastern District of Wisconsin granted in part and denied in part a multispecialty medical group’s motion to dismiss a False Claims Act suit under state and federal law brought by a former employee.  The former employee worked in the medical group’s billing department and alleged that the medical group violated the False Claims Act by, among other things, upcoding bills for evaluation and management services (“E/M services”) and submitting claims to Medicare with physicians’ stamped signatures.

The medical group filed a motion to dismiss.  With respect to the upcoding claims, the court denied the medical group’s motion, concluding that “[a]lthough [relator] does not allege that [the medical group] knew that specific requests for reimbursement for E/M services were false, she claims that [the medical group] ignored audits disclosing a high rate of up coding and ultimately eliminated audits altogether.”  Regarding the claim rooted in the use of stamped signatures, the court dismissed it, finding that “[t]he fact that [a physician] used a signature stamp does not mean that claims for payment for his services were fraudulent.”

Lastly, the court allowed the relator’s retaliation claim under the False Claims Act to go forward.  According to the court, the relator’s allegations that the medical group told her to stop “digg[ing] up problems,” required her to meet with a supervisor, and then discharged her in response to her reports of fraud were enough to suggest she had been fired because of the actions she took in furtherance of her False Claims Act suit.