U.S. ex rel. Donegan v. Anesthesia Assocs. of Kan. City, PC — Aug. 2016 (Summary)

QUI TAM RELATOR

U.S. ex rel. Donegan v. Anesthesia Assocs. of Kan. City, PC
No. 15-2420 (8th Cir. Aug. 12, 2016)

The United States Court of Appeals for the Eighth Circuit affirmed a group of anesthesiologists’ motion for summary judgment against a relator, who brought a qui tam action, alleging that the anesthesiologists violated the False Claims Act by submitting Medicare reimbursement claims for anesthesia services knowing that they did not comply with the Medicare conditions of payment.

The relator maintained that the anesthesiologists failed to comply with the Medicare regulation requiring anesthesiologists to personally participate in the most demanding aspects of the anesthesia plan, including induction and emergence, because the anesthesiologists were, essentially, never present with patients during emergence but rather during the patient’s time in the Post-Anesthesia Care Unit (“PACU”). The relator claimed that despite knowing of their noncompliance, the anesthesiologists nevertheless sought Medicare reimbursement.

Taking into account that the conclusion that the regulation in question is ambiguous and that during discovery, medical experts for both parties agreed that “emergence” is a medical term referring to a post-surgery recovery process that can extend into the recovery room, the court concluded that the anesthesiologists’ interpretation – emergence meaning the patient’s continued recovery in the PACU – was objectively reasonable. Because an objectively reasonable interpretation is insufficient to give rise to a False Claims Act, the court affirmed the lower court’s grant of summary judgment.