Payne v. Sanon

CourtDistrict Court, M.D. Florida
DecidedJanuary 29, 2021
Docket8:18-cv-00365
StatusUnknown

This text of Payne v. Sanon (Payne v. Sanon) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Payne v. Sanon, (M.D. Fla. 2021).

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION

DARREN PAYNE,

Plaintiff,

v. Case No: 8:18-cv-365-T-36TGW

ASHISH SANON,

Defendant. ___________________________________/ ORDER This matter comes before the Court on Defendant Ashish Sanon, M.D.’s Dispositive Motion to Dismiss First Amended Complaint (Doc. 41) and Motion to Strike First Amended Complaint (Doc. 42). Defendant moves to dismiss, with prejudice, Relator’s First Amended Complaint, brought pursuant to the False Claims Act, for failing to state a claim and failing to plead fraud with the particularity required by Fed. R. Civ. P. 9(b). Relator responded in opposition to the motion to dismiss (Doc. 46), and Defendant replied (Doc. 49). In his motion to strike, Defendant seeks to strike allegations in the First Amended Complaint he claims are scandalous, immaterial, and impertinent. Relator does not oppose the motion to strike. See Doc. 43. The Court, having considered the motions and being fully advised in the premises, will grant Defendant’s motion to dismiss and will dismiss the First Amended Complaint, without prejudice. Because the First Amended Complaint will be dismissed, the motion to strike will be denied as moot. The Court will permit Relator the opportunity to file a Second Amended Complaint. I. BACKGROUND1

Defendant, Ashish Sanon, M.D., is an ophthalmologist who formerly practiced medicine in Citrus County, Florida. Doc. 38 ¶¶ 21, 23–24. Relator, Darren Payne, M.D., is also an ophthalmologist, licensed to practice in the State of Florida. Id. ¶ 20. Relator purchased Defendant’s ophthalmology practice in 2016, allegedly induced to

purchase the practice due to its profitability. Id. ¶ 21. Relator states Defendant reported that “he was in the top 3% of solo practitioners in terms of billing; that he was making approximately $400 per month from each of his Medicare patients.” Id. After the purchase of the practice and in reviewing patient charts provided by the Defendant, Relator claims he discovered years of Medicare fraud conducted by the Defendant. Id.

¶¶ 22, 72. Relator specifically alleges that while practicing ophthalmology, Defendant would falsely diagnose patients as being “glaucoma suspect” 2 so that Defendant could provide unnecessary services to the patients and subsequently bill Medicare for the services. Id. ¶ 45. These services would consist of various eye examinations that aid in

identifying glaucoma symptoms but that generally would not be covered by Medicare

1 The following statement of facts is derived from the Plaintiff’s Amended Complaint (Doc. 38), the allegations of which the Court must accept as true in ruling on the instant motion. See Linder v. Portocarrero, 963 F.2d 332, 334 (11th Cir. 1992); Quality Foods de Centro Am., S.A. v. Latin Am. Agribusiness Dev. Corp. S.A., 711 F.2d 989, 994 (11th Cir. 1983). 2 “A patient is considered glaucoma suspect if he does not currently suffer from glaucoma, but presents characteristics suggesting a high risk of developing glaucoma.” Doc. 38 ¶ 47. unless conducted on patients who are identified as glaucoma suspect. Id. ¶ 48. The tests conducted as part of this alleged scheme include Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI),3 fundus photography,4 and visual field

examinations.5 Id. ¶¶ 52–59. Each of these tests have specific Local Coverage Determinations (LCDs) which state when a service will be considered “medically reasonable and necessary” by Medicare and thus covered by the program. Id. ¶¶ 49, 52–59.

Relator also alleges that Defendant conspired with other physicians to engage in the above described scheme, identifying Dr. Francesann Ford and Dr. Donghai V. Ho as co-conspirators and also stating that more, presently unnamed, individuals may be involved. Id. ¶¶ 103–104. He alleges that these physicians were engaged as locum tenetes,6 or locums, while Defendant was not practicing medicine. Id. ¶ 102. The

Relator explains that the locums allegedly submitted false claims to Medicare for reimbursement and also created false records in furtherance of these false claims,

3 SCODI consists of a number of different tests, “which are performed for the purpose of detecting glaucomatous damage to the nerve fiber layer or optic nerve of the eye.” Doc. 38 ¶ 52. The specific test allegedly conducted by Defendant is Heidelberg retina tomography, “which is used to examine the back of the eye.” Id. at n.15. 4 Fundus photography uses a retinal camera, for diagnostic purposes, to photograph the vitreous, retina, choroid, and optic nerve. Doc. 38 ¶ 55. 5 A “visual field examination” is a test used to detect loss of vision, a symptom of glaucoma. Doc. 38 ¶ 58. 6 Locum tenetes or “locums” are “physicians working as independent contractors, sometimes through temp agencies, who are sometimes hired to ‘cover’ for physicians who are on vacation, maternity leave, etc.” Doc. 38 ¶ 102. agreeing to “follow Defendant’s practice of falsely diagnosing Medicare patients as glaucoma suspect.” Id. ¶ 104. Relator is aware of over 400 Medicare patients on which the Defendant

conducted these eye tests between 2009 and 2016, based on the false glaucoma suspect diagnosis. Id. ¶ 51. Of these 400 patients, Relator gives the details of four patients under the pseudonyms “Greene,” “Roe,” “Smith,” and “Pink,” who are typical of the group. Id. According to Relator, each of these patients received a glaucoma suspect diagnosis

without any clinical indications described in the record to support such a diagnosis. Id. ¶¶ 74–94. Medical records of these patients are attached to Relator’s Amended Complaint as well as summarized within the pleading. Id.; see Docs. 38-10–38-14. Each of the four named patients are Medicare beneficiaries who were first seen by Defendant sometime between 2008 and 2010. Doc. 38, ¶¶ 74, 82, 86, 91. They each

received a diagnosis of Glaucoma Suspect over the course of their treatment with Defendant and received several rounds of the SCODI, fundus photography, and visual field examination testing. Id. ¶¶ 78, 84, 88, 93. Patients Greene and Roe were seen by Dr. Ford and Dr. Ho one time each, and at these visits a Glaucoma Suspect diagnosis was noted. Id. ¶¶ 78, 84; see also Doc. 38-10 at 6, 10; Doc. 38-11 at 2, 6. Patients Smith

and Pink were not seen by Drs. Ford and Ho, according to Relator’s allegations. Doc. 38 ¶¶ 88, 93. Relator specifically alleges that Medicare claims were made for each of these patients based on the fraudulent Glaucoma Suspect diagnoses, stating that “Defendant and/or his co-conspirators ordered VFE’s, fundus photography, and SCODI testing on numerous occasions, and sought and received Medicare reimbursement for each such instance.” Id. ¶¶ 77, 83, 87, 92. On May 12, 2020, Relator filed his First Amended Complaint7 against

Defendant, asserting three claims under the Federal False Claims Act, 31 U.S.C. §§ 3729, et seq. Doc. 38. In Count One, Relator alleges a violation of § 3729(a)(1)(A) for presenting false or fraudulent claims to Medicare for payment. Doc. 38 ¶¶ 107–114. In Count Two, Relator alleges a violation of § 3729(a)(1)(B) for knowingly making or using false records or statements material to false or fraudulent claims for payment.

Doc. 38 ¶¶ 115–120. Finally, in Count Three, Relator sues Defendant for conspiracy, alleging Defendant conspired with Drs.

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Payne v. Sanon, Counsel Stack Legal Research, https://law.counselstack.com/opinion/payne-v-sanon-flmd-2021.