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Federal court exonerates physician on false claim government charges
Posted in General

A federal district court in Nevada recently exonerated a Las Vegas nephrologist of charges by the government that he had knowingly submitted false claims for Medicare payment. The court found that the situation presented was highly unusual, and the physician’s failure to comply with Medicare billing rules was not intentional since made under rules that were far from clear in the situation.

Since the hospital was obligated to provide services to the indigent, it recruited a local physician to deal with two patients in endstage renal failure who were uninsured, were abusive to treating personnel as well as non-compliant with prior physician direction. According to the facts in the case, the patients had been refused treatment at all 10 certified outpatient dialysis patient centers in the local community.

The nephrologist saw the patients in the hospital’s emergency department, and the nephrologist billed his services as inpatient services. The hospital directed the nephrologist to bill the patients as inpatients, and the court concluded that the nephrologist had reasonably believed that the patients were inpatients of the hospital. However, the patients were never actually admitted to the hospital from the emergency room. Further, the services to the patients could not be billed as outpatient treatments, because the hospital was not an authorized outpatient treatment dialysis treatment facility.

The court stated that the physician reasonably relied on information provided to him by the hospital that the patients were admitted for dialysis to the emergency room and were to be treated as inpatients, notwithstanding the insistence by the government that a 23-hour admission could not be characterized as an inpatient admission. The court further noted that the situation with these patients and the hospital was highly unusual, with no clear regulations, directions, guidelines or experience available to deal with the situation.

Although the hospital may have been confused or wrong about how the patients should have been treated and billed, this was not evidence that the physician knowingly violated the False Claims Act or acted with deliberate ignorance or reckless disregard of the Medicare billing rules, concluded the court. U.S. v. Ovuworie (D.Ct. Nev. 3/1/07)

  • Partner

    John is a partner in the firm's Estate Planning Department. He focuses his practice on estates, trusts, family business and disability planning, and the administration of estates and trusts. John also has an active health law ...

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