U.S. ex rel. Ketroser v. Mayo Found. — Sep. 2013 (Summary)

FALSE CLAIMS ACT, QUI TAM

U.S. ex rel. Ketroser v. Mayo Found.
No. 12-3206 (8th Cir. Sept. 4, 2013)

A plaintiff’s attorney and three others filed a False Claims Act case based on information learned during discovery in a malpractice case, claiming that the hospital system billed Medicare for surgical pathology services it did not provide.  The United States Court of Appeals for the Eighth Circuit dismissed four relators’ qui tam action, holding that the billing codes applicable to the hospital system’s claims do not require written reports for surgical pathology services.  The court found that neither the Medicare regulations nor the American Medical Association Codebook require physicians using the CPT codes for surgical pathology services to prepare additional written reports, the kind which the relators claim the hospital system fraudulently failed to provide.