False Claims Charges vs. Eye Clinic Sufficiently Specific

Michael Sorenson is an optometrist formerly employed by Outreach Diagnostic Clinic.  After he quit, he filed a False Claims action against the eye clinic and the two doctors who owned it.  He alleged that the clinic routinely billed Medicare for tonography (i.e., eye pressure) tests that were never performed and that, in fact, the clinic didn’t even have the equipment necessary for tonography tests.  The government joined the suit, alleging that the defendants filed at least 14,450 false Medicare claims and received at least $807,450 for tonography tests that were never performed.

Citing Rule 9(b)’s requirement that fraud must be alleged with specificity, the defendants moved to dismiss.  They argued that the government relied on “group allegations” rather than specifying what each defendant had done and that the government hadn’t specified the dates and times of the false bills.

On May 26 the court denied the motion to dismiss, ruling that “[w]hile this claim for fraud has a heightened pleading standard, it is not so high as to require the government to prove its case as it would at trial.”  The court noted that Michael’s allegations—assumed to be true for purposes of ruling on the motion–included a description of his observations of a false claims scheme, the time frame when he observed it, each defendant’s role in the scheme, and the billing codes that were used.

The case is U.S. ex rel. Sorenson v. Outreach Diagnostic Clinic, No. 12-cv-480 (S.D. Tex., May 26, 2016).

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