LANSING, Mich.--(BUSINESS WIRE)-- Health care providers do not have to worry about protecting themselves from frivolous claims from outside contractors thanks to a recent Sixth Circuit Court of Appeals ruling, United States ex rel. Chesbrough v. VPA, PC, dba Visiting Physicians Ass'n, No. 10-1494, 2011 WL 3667648 (6th Cir. Aug. 23, 2011).
Dr. Richard Chesbrough, a radiologist, has his own radiology service business and contracted with VPA, the nation's largest home call physician service, to review x-rays taken of patients on behalf of VPA. Chesbrough was critical of what he thought were less than optimum quality radiographs. After six months in working with VPA, Chesbrough filed a qui tam or whistleblower action claiming that if the radiographs were less than satisfactory, VPA must have submitted false claims when they sought Medicare reimbursement for Chesbrough's review services, and therefore in direct violation of federal and Michigan False Claims Acts (FCA). The federal government declined to intervene in the complaint. The district court agreed to dismiss the action under Rule 9(b), noting Chesbrough was "unable to provide dates or particularities for even a single claim that was submitted to the government...”
The Sixth Circuit Court ruled that Dr. Chesbrough's failure to plead a fraud case with particularity was fatal to his effort to be a whistleblower from the outside under Chesbrough v. VPA, “Medicare does not require compliance with an industry standard as a prerequisite to payment,” the appeals court noted. He was only a contractor and had no actual knowledge as to whether VPA, in fact, filed any claims regarding his services.
“The case is important,” said Lansing attorney Max Hoffman, who represented VPA, “because it establishes the principle that a contractor or outside agent will not be able to push a health care provider to the expense of protecting itself against frivolous claims from opportunistic claimants. Because every qui tam action requires review and potential investigation by the federal government, every whistleblower's suit is a risk to a health care provider. This case eliminates one category of frivolous claims, conserving health care dollars and reducing exposure for legitimate health care providers.”
For more information on this case and related matters dealing with health care provides, please visit www.fraserlawfirm.com.
About Fraser Trebilcock
Fraser Trebilcock is one of Michigan’s longest-established full-service law firms. Since 1883 Fraser Trebilcock has been providing preeminent legal services and representation to small and large businesses, individuals, governmental entities, and associations. With offices in Lansing, Detroit, Grand Rapids and Washington, D.C., and through its association with the State Capital Group, Fraser Trebilcock has access to a global network of independent law firms. Member firms of the State Capital Group practice independently and not in a relationship for the joint practice of law. More information is available at www.fraserlawfirm.com | www.statecapitalgroup.org.
CONTACT:
Fraser Trebilcock
Daniel Cherrin, (517) 377-0865
[email protected]
KEYWORDS: United States North America Michigan
INDUSTRY KEYWORDS: Surgery Practice Management Health Cardiology Hospitals Radiology Professional Services Insurance Legal General Health Managed Care
MEDIA:
| Logo |