The federal False Claims Act results in a host of interesting relator claims. This one caught my eye. In United States of America v. Intermountain Healthcare, Inc., Case No. 2:20-cv-00372-TC-CMR (U.S. Dist. Ct. D. Utah 1/28/2022), the relator alleged that anesthesiologists participating in his medical group often spent time during surgeries playing on their phones or other personal electronic devices. Some allegedly watched football, others paid bills. Naturally, the relator alleged that the anesthesiologists were not paying attention to their patients, and as a result, claims submitted for reimbursement to the federal government for their services were in violation of the False Claims Act.
The United States District Court for the District of Utah didn’t see quite it that way. Carefully walking through the exact coding language, the court concluded that based upon the facts alleged by the Relator, none of the applicable billing codes created a factually false cause of action under the False Claims Act. As a result, many of the allegations were dismissed. The court did rule, however, that the relator successfully alleged that the anesthesiologists’ use of personal electronic devices during surgery constitutes a legally false claim worthy of further litigation. In preserving these claims, the court relied upon the Medicare requirement that for reimbursement, the service must be “reasonable and necessary”. The court then applied a prior ruling from the 10th Circuit in which “reasonable and necessary” requires compliance with all “accepted standards of medical practice” – arguably a very broad interpretation. In other words, if the medical provider’s conduct doesn’t comply with “accepted standards of medical practice” then it may not be “reasonable and necessary” under the Medicare billing requirements, thereby creating a viable False Claims Act case.
This case is not over. The parties will now be left to debate whether the allegations are true, and if so, whether the relator can satisfy his burden of proving that the anesthesiologists submitted legally false claims to the federal government under the “reasonable and necessary” standard. I’ll check my phone for updates.
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