Addressing a recent motion to dismiss, the Northern District of California predominantly denied Kaiser Permanente’s (“Kaiser”) motion to dismiss the government’s complaint in United States ex rel. Osinek v. Permanente Medical Group, Inc., and the court is allowing the government leave to amend to attempt to address any short-fallings within its complaint. No. 13-CV-03891-EMC, 2022 WL 16925963 (N.D. Cal. Nov. 14, 2022). A motion to dismiss is not outcome determinative of the ultimate merits of a case, and for purposes of the court’s analysis the alleged facts and theories are construed by the court in the light most favorable to the party whose action would be dismissed, in this case the government’s complaint.
As we discussed in Managed Care & The FCA: Are Courts Getting It Right?, this case is premised on whether Kaiser submitted false claims for payments when it allegedly augmented patient medical records to add diagnoses that either did not exist or were unrelated to the patient’s visit with the Kaiser physician. The court first considered whether the Government’s theories of liability were predicated on factual falsity, legal falsity, or both.
The court found that factual falsity could be implicated in two ways: (1) if a diagnosis of a medical condition was claimed but the medical condition did not exist (i.e., the diagnosis was clinically inaccurate) and (2) if a claim for payment was based on a diagnosis of a medical condition that did exist, but the condition...
BRENTWOOD, Tenn. (WSMV) - A Tennessee doctor has pleaded guilty to committing millions of dollars’ worth of Medicare fraud through her Brentwood optometry practice. Helen Boerman, 48, pleaded guilt...