U.S. ex rel. Troxler v. Warren Clinic, Inc. — Oct. 2015 (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Troxler v. Warren Clinic, Inc.
No. 14-5144 (10th Cir. Oct. 28, 2015)

The United States Court of Appeals, Tenth Circuit affirmed the dismissal of a physician’s False Claims Act suit against a health clinic where he previously worked. The physician alleged that nurses and medical assistants improperly collected “History of Present Illness” (“HPI”) information from patients. According to the physician, since HPI information is necessary to select the proper billing code for evaluation and management services and must be supported by a physician’s documentation, the clinic was fraudulently billing Medicare and Medicaid and violating the False Claims Act.

In affirming the decision of the district court dismissing the physician’s claims, the court held that the physician failed to plead a plausible false claim. The court concluded, among other things, that the complaint failed to state a factually false claim because “there [were] no allegations that the clinic submitted anything false to the government or that the services were not actually provided.”