False Claims Act

United States ex rel. Frazier v. Iasis Healthcare Corp., No. CV 05-766-PHX-JAT (D. Ariz. Apr. 21, 2008)

The United States District Court for the District of Arizona dismissed a False Claims Act ("FCA") suit brought against a health care corporation by its former chief compliance officer, holding that a complaint cannot sufficiently allege a claim under the FCA for Stark Law and Anti-Kickback Statute violations without presenting details concerning the actual Medicare referrals, billing and payment for the services provided to the Medicare patient. The court noted that the submission of a certification of billing compliance is also required for such claims.

The court held that the allegation that the corporation had billed Medicare for medically unnecessary procedures was insufficient because the complaint failed to provide a specific surgery, dates, or actual submitted claims for Medicare funds. The court went on to find that the second allegation, that the corporation had impermissibly compensated physicians in return for patient referrals, also failed because the complaint did not provide details regarding the referral of Medicare-eligible patients or the submission of claims for payment resulting from the allegedly impermissible relationships between the corporation and certain physicians.