GOVERNMENTDoctors win when novel use of False Claims Act rejectedJudge rules for physicians in dismissing a lawsuit tying self-referral violations to the federal fraud law. But the issue could re-emerge.By Tanya Albert, amednews staff. March 11, 2002. A federal judge threw out a first-of-its-kind lawsuit that accused physicians of violating the False Claims Act even though they billed Medicare for procedures they performed and used the correct CPT codes when they asked for their reimbursement. If the government's case had succeeded, any Stark violation could have automatically created a False Claims Act violation. "We knew we couldn't lay down for these people," said Larry Pack, MD, a Flint, Mich., orthopedic surgeon and one of the physicians at Family Orthopedic Realty named in the lawsuit. "If they had won, we knew it would have tremendous implications for doctors nationwide. It was a test case." About 4 1/2 years ago, the government accused the group of orthopedic surgeons of violating the Stark II regulations governing physician self-referrals and the federal anti-kickback statue. The physicians charged McLaren Regional Medical Center in Flint too much rent for space in a building the physicians owned, prosecutors argued. The government then went a step further and said the physicians had violated the False Claims Act and owed the government more than $9 million. Prosecutors said hospital officials had signed papers certifying that the facility was compliant with all federal regulations. But, the government charged, the hospital violated the Stark II and anti-kickback statues, so it wasn't in compliance with all federal statutes. Consequently, the Medicare claims that the hospital made when it had an improper financial agreement with the physicians were false claims, the government argued.
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Copyright 2002 American Medical Association. All rights reserved.
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