QUI TAM
U.S. v. R&F Props. of Lake County, Inc., No. 04-15283 (11th Cir. Dec. 30, 2005)
The Eleventh Circuit Court of Appeals held that the district court erred
when it granted a clinic's motion for summary judgment in a qui tam action
brought by a former employee. The clinic allegedly violated the False Claims
Act by submitting Medicare claims for services performed by physician assistants
and nurse practitioners as if they were supervised by a physician when they
were not. The district court granted the clinic's motion for summary judgment,
finding that its interpretation of the Medicare regulations was reasonable
in light of the ambiguous language therein. The Eleventh Circuit disagreed,
holding that the evidence showed the clinic knew that a physician was required
to be physically present in the office suite in order to meet the criteria
necessary for billing in that manner.