United States v. Krizek case brief

United States v. Krizek case brief summary
859 F.Supp. 5 (1994)

CASE SYNOPSIS

Plaintiff government filed suit against defendants, a doctor and his billing clerk, alleging false billing for Medicare and Medicaid patients in violation of the False Claims Act (Act), 31 U.S.C.S. §§ 3729-3731, and common law.

CASE FACTS
The government argued that the doctor and his billing clerk submitted bills coded for a service with a higher level of reimbursement than was provided by the doctor. The government also alleged that the doctor performed services that should not have been performed at all in that they were not medically necessary. 

DISCUSSION

• The court found that the doctor did submit claims when he did not provide patient services for the amount of time that was billed. 
• The court found that the doctor and his billing clerk acted with reckless disregard as to the truth or falsity of the submissions, and their conduct constituted a violation of the Act. 
• The court issued an injunction that enjoined the doctor and his billing clerk from participating in Medicare and Medicaid until they could show the court that they could abide by the relevant rules.

CONCLUSION
The court found the doctor and his billing clerk liable for submitting false claims for payment to the government.

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