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United States ex rel. Polukoff v. St. Mark’s Hosp., 895 F.3d 730, 734 (10th Cir. July 9, 2018)

Jul 9, 2018

This appeal arose from a qui tam action alleging violations of the False Claims Act (“FCA”) by a medical doctor who allegedly performed thousands of unnecessary heart surgeries and received reimbursement through the Medicare Act by certifying that the surgeries were medically necessary.  The district court granted the defendants’ motion to dismiss, reasoning that a medical judgment could not be false under the FCA.  The Tenth Circuit reversed and remanded, holding that a doctor’s certification that a procedure is reasonable and necessary is false under the FCA if the procedure was not reasonable and necessary under the government’s definition of that phrase.