Ketroser, et al. v. Mayo Foundation, et al., No. 12-3206 (8th Cir. 2013)
Annotate this CaseRelators brought a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A) and (B), alleging that the Mayo Foundation and others billed Medicare for surgical pathology services it did not provide. The government intervened and the parties settled. Relators then filed a Second Amended Complaint asserting additional claims. On appeal, relators challenged the district court's dismissal of their additional claim that Mayo fraudulently billed for services it did not provide whenever it prepared and read a permanent tissue slide but did not prepare a separate written report of that service. As a preliminary issue, the court concluded that relators satisfied their burden of showing that the public disclosure bar did not deprive the court of jurisdiction over relators' claim. On the merits, the court concluded that nowhere in the Medicare regulations or in the American Medical Association Codebook has the court found a requirement that physicians using the CPT codes for surgical pathology services must prepare the additional written reports that relators claimed Mayo fraudulently failed to provide. Accordingly, the court affirmed the judgment of the district court.
Court Description: Civil case - False Claims Act. District court did not err in granting judgment for defendant on plaintiff's claim Mayo fraudulently billed for services it did not provide when it did not prepare a separate written report whenever it prepared and read a permanent tissue slide as the billing codes applicable to the claims submitted by Mayo did not explicitly require written reports and the regulation that sets forth the Medicare conditions of payment did not require a written report for surgical pathology services.
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