U.S. ex rel. Gravett v. Methodist Med. Ctr. of Ill. – March 2015 (Summary)

QUI TAM – FALSE CLAIMS ACT, ORIGINAL SOURCE

U.S. ex rel. Gravett v. Methodist Med. Ctr. of Ill., Case No. 12-1008 (C.D. Ill. Mar. 4, 2015)

The United States District Court for the Central District of Illinois dismissed a False Claims Act lawsuit brought by an ED physician against the hospital where he used to work, holding that, with respect to the patients treated after the physician stopped working at the hospital, the physician could not establish that he had any direct, independent knowledge of the patients and their treatments. In fact, the court held, the physician was not the original source of information on which the claims were based. Instead, the physician had gathered the information supporting those claims from the U.S. Attorney’s Office (to whom the information had been disclosed by the hospital during prior investigations).

With respect to false claims alleged to have been made with respect to patients treated while the physician was working at the hospital, the court held that the physician failed to plead sufficient particularity. Specifically, the court noted that the physician merely speculated that, after using a software program to upcode the services actually provided by physicians, the hospital caused false claims to be submitted for Medicare reimbursement. The failure to provide specific information concerning at least one false claim actually submitted to the government was deemed fatal to the physician’s claims.