The Seventh Circuit recently reversed a lower court’s ruling that an amended complaint in a qui tam lawsuit filed under the False Claims Act (FCA) alleging fraudulent anesthesiology billing practices failed to meet the pleading standard under Rule 9(b) of the Federal Rules of Civil Procedure. In U.S. ex. rel. Mamalakis vs. Anesthetix Management LLC, — F.4th —-, 2021 WL 5818476 (Dec. 8, 2021), the Seventh Circuit reversed the district court’s dismissal and held that the amended complaint included enough detail to satisfy Rule 9(b)’s pleading benchmark, allowing the case to move forward.
The case was brought by Dr. John Mamalakis, a Wisconsin-based anesthesiologist, against his former employer, Anesthetix Management LLC, d/b/a Anesthetix of TeamHealth, a company acquired by TeamHealth Holdings, Inc. (“TeamHealth”). Dr. Mamalakis claimed that TeamHealth fraudulently overbilled Medicare and Medicaid for services performed by its anesthesiologists. The original complaint only included general allegations. After dismissal (and the U.S. government declining to intervene), Dr. Mamalakis filed an amended complaint with ten specific examples of allegedly fraudulent billing.
Under federal regulations, procedures that are “personally performed” by anesthesiologists qualify for the highest billing rate. Procedures that are “medically directed” by anesthesiologists qualify for payments at a lower rate, but one that is significantly higher than the rate paid for procedures that are...
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