U.S. ex rel. Napoli v. Premier Hospitalists PL — Jan. 2017 (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Napoli v. Premier Hospitalists PL
Case No. 8:14-cv-2952-T-33TBM (M.D. Fla. Jan. 12, 2017)

The United States District Court for the Middle District of Florida denied a physician, billing entity, and a hospitalist organization’s motion (collectively, the “organization”) to dismiss against the relators of a qui tam action.  The three relators, a nurse practitioner, former vice president of the hospitalist organization, and former medical administrator of the hospitalist group alleged violations of the False Claims Act by the organization.

The court held that the relators sufficiently pled with particularity improper billing practices by the organization which allegedly led to false claims being presented to and paid by the government.  While none of the relators were able to personally submit fraudulent bills, they each had access to documents and were in a position to observe the organization’s billing practices.  During the relators’ employment with the organization, the relators allegedly discovered improper billing practices and interviewed other employees for confirmation of their findings.

Additionally, the court found that the relators pled with sufficient particularity that a conspiracy existed between members of the organization.  The relators alleged that members of the organization were well aware through its communications with the billing entity that it was billing Medicare and Medicaid for patients never being seen, yet billed like they had.  Also, the relators alleged that they personally spoke with the owner and manager of the billing solutions and confirmed that they were aware of the policies.  As such, the court concluded that the relators sufficiently alleged that a member of the organization took an overt step of submitting a false claim to be paid, and which was a sufficient pleading with particularity of an FCA violation capable of withstanding the organization’s motion to dismiss.