A Turkey of a Qui Tam Suit: Case Dismissed Before Dinner Was Served
The United States Court of Appeals for the Fifth Circuit affirmed a district court’s dismissal of a qui tam action filed under the False Claims Act for alleged improper Medicare billing. A former sales representative alleged that the hospital used non-medical staff to make clinical judgments during patient screenings, leading to inaccurate Medicare billing. A lower court dismissed the claims, agreeing with the hospital that Medicare rules allow non-medical employees to collect information as long as licensed medical professionals make the actual medical decisions. The appellate court agreed, indicating that the sales representative failed to allege facts showing that sales representatives like her acted as clinicians or provided false clinical judgments. U.S. ex rel. Gentry v. Encompass Health Rehabilitation Hospital of Pearland
Feast for the Defense: Summary Judgment on the Menu
The United States District Court for the Southern District of Alabama granted a hospital’s motion for summary judgment after a physician filed suit claiming disability discrimination and failure to accommodate following the termination of his employment. The physician, a trauma and critical care surgeon, could no longer perform trauma duties due to mobility limitations. After agreeing to restrict his role to wound care, the hospital terminated him because his contract required full trauma privileges. The court ruled that the termination was lawful and not a pretext for discrimination under the Rehabilitation Act because trauma surgery was an essential function of the physician’s role, and he could not perform it even with reasonable accommodation. It also held that restructuring the position to remove surgical duties was unreasonable since it would eliminate a core job requirement. Barber v. USA Health Care Management, LLC