On July 3, 2018, the U.S. District Court for the Northern District of Illinois issued a ruling dismissing Advocate Christ Medical Center (ACMC) from a False Claims Act suit brought by a former resident against ACMC and a separate surgeon group.  The case involves allegations that teaching hospital ACMC and the surgeon group improperly billed Medicare and Medicaid for surgeries performed without the assistance of residents.  The relator contended, among other things, that ACMC and the surgeon group improperly billed and were paid for the use of physician assistants at surgery when residents were available to assist with the surgeries, and that ACMC submitted false Medicare cost reports (MCRs) to CMS when it sought graduate medical education (GME) funding associated with such surgeries.  The case is an example of the limits of imputing liability to a hospital for services and billing of its medical staff.

The district court initially denied ACMC’s motion to dismiss the second amended complaint.  However, upon ACMC’s request for reconsideration of that ruling, the court found that ACMC’s MCR certifications did not extend to services provided by the surgeon group.  Therefore, the MCRs (through which ACMC received GME funding) did not make any false representations about the surgeon group’s services.  The court further found that ACMC could not be liable under the FCA for another party’s fraudulent billing practices.  The court went on to say that “to state a claim, Relator would have to be able to allege that ACMC took an ‘active role’ in submitting false claims or material fraudulent documents to the government.” 

The case is United States v. Advocate Christ Medical Center, Case No. 13-cv-1826 (N.D. Ill.). The district court opinion, in which the court dismissed ACMC with prejudice, is available here.