HCA defeats whistleblower's billing fraud suit

Nashville, Tenn.-based HCA Healthcare and others have defeated a whistleblower's allegations that they improperly billed federal healthcare programs for physical therapy services, according to Bloomberg Law

The plaintiff, Edward Ernst Jr., filed the suit against HCA Healthcare, HCA Midwest Health and three other defendants in February 2019. Mr. Ernst, who previously worked for one of the defendants, alleged they submitted false claims to Medicare and Tricare for physical therapy services provided in Overland Park, Kan., and Olathe, Kan., from April 2017 to August 2018. The federal government declined to intervene in the case in April 2019. 

A Kansas federal court dismissed the lawsuit Nov. 23, stating Mr. Ernst failed to provide details about actual claims submitted by the defendants to federal healthcare programs. 

"In the amended complaint, plaintiff has provided no details about the actual claims submitted by defendants to Medicare and Tricare; instead, he has merely alleged a date range for the provision of services as part of the underlying schemes, as well as the allegation that fee slips describing services (including particular treatment codes) were submitted to HCA defendants for eventual billing to Medicare and Tricare," Judge John W. Lungstrum of the U.S. District Court for the District of Kansas wrote in the memorandum dismissing the lawsuit. 

The judge held that the plaintiff did not sufficiently plead his False Claims Act claims with the required particularity. 

"Although there may be a basis to infer that claims were submitted by defendants to Medicare and Tricare based on fee slips, plaintiff has not explained how those claims contained false statements," the judge said. 

In addition to HCA Healthcare and HCA Midwest Health, College Park Family Care Center Physicians Group, College Park Physical Therapy and College Park Family Care Center were named as defendants. 

More articles on legal and regulatory issues:
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Ex-employee sentenced for defrauding Georgia hospital to buy 93 guns

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