Doctors’ FCA Claim Against Hospital Survives Summary Judgment

On November 10, 2010, U.S. District Court Judge Maurice B. Cohill, Jr., of the Western District of Pennsylvania denied the defendant’s Motion for Summary Judgment, thereby permitting the qui tam action by the doctors and U.S. Government to go forward.  Doctors Dilbagh Singh, Paul Kirsch, Rao Nadella, and Martin Jacobs filed a qui tam action pursuant to the False Claims Act against Bradford Regional Medical Center (“BRMC”), V&S Medical Associates, LLC, Peter Vaccaro, M.D., and Kamran Saleh, M.D.  Doctors Singh, Kirsch, Nadella and Jacobs alleged that the Defendants submitted, or caused to be submitted, false claims for Medicare payment which arose out of referrals from Doctors Vaccaro and Saleh to the BRMC in violation of the Stark Act and the Anti-Kickback Act.  The Stark Act is contained at Section 1395 of Title 42 of the United States Code and prohibits a physician from making a referral to an entity for the provision of Medicare- or Medicaid-paid services where the physician has a financial relationship with the entity.  The False Claims Act prohibits any individual or business from submitting, or causing someone else to submit, a false or fraudulent claim or payment to the government.

In his Opinion and Order, Judge Cohill stated that (1) financial relationship existed between BRMC and Doctors Vaccaro and Saleh pursuant to the Stark Act, (2) none of the exceptions under the Stark Act applied to the defendants, (3)  none of the “safe harbor” provisions under the Anti-Kickback Act applied to the Defendants, and (4) BRMC submitted claims for payment to Medicare based on referrals from Doctors Vaccaro and Saleh pursuant to the Stark Act and received payment from Medicare for such claims.

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