U.S. ex rel. Troxler v. Warren Clinic, Inc. (Summary)

FRAUD AND ABUSE

U.S. ex rel. Troxler v. Warren Clinic, Inc., No. 11–CV–808–TCK–FHM (N.D. Okla. Nov. 5, 2014)

The United States District Court for the Northern District of Oklahoma granted a motion to dismiss filed by a physician group and affiliated hospital in defense of a qui tam lawsuit. The lawsuit was filed by a physician formerly employed by the group, who argued that the group violated the False Claims Act by permitting “unqualified personnel” to obtain and record patients’ History of Present Illness (“HPI”) during office visits. The physician claimed that this was a violation of the Evaluation and Management Services Guide (“Guide”) published by the Department of Health and Human Services, which does not specifically authorize non-physicians to obtain a patient’s HPI.

The court found this argument unpersuasive. It noted that the physician’s lawsuit was based on a “lone provision” in the Guide that had not been demonstrated to have a legally binding effect on healthcare providers. Furthermore, it explained that even if the Guide were legally binding, perfect compliance with HPI regulations is not a condition of payment. Consequently, the court held that a failure to meet the Guide’s requirements could not possibly give rise to a false claim. The court dismissed the physician’s lawsuit with prejudice.