United States Ex. Rel. Lam v. Tenet Healthcare Corp.

481 F. Supp. 2d 689, 2007 U.S. Dist. LEXIS 28400, 2007 WL 989140
CourtDistrict Court, W.D. Texas
DecidedMarch 28, 2007
Docket2:02-cr-00525
StatusPublished
Cited by4 cases

This text of 481 F. Supp. 2d 689 (United States Ex. Rel. Lam v. Tenet Healthcare Corp.) is published on Counsel Stack Legal Research, covering District Court, W.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States Ex. Rel. Lam v. Tenet Healthcare Corp., 481 F. Supp. 2d 689, 2007 U.S. Dist. LEXIS 28400, 2007 WL 989140 (W.D. Tex. 2007).

Opinion

ORDER

CARDONE, District Judge.

On this day, this Court considered the United States of America’s “Motion to Partially Intervene for the Purpose of Dismissing the Relators’ Outlier Allegations and Memorandum in Support” (“Motion to Intervene”) and “Motion to Dismiss Rela-tors’ Outlier Allegations” (“Government’s Motion to Dismiss”), in addition to Defendant Tenet Healthcare Corporation’s “Motion to Dismiss Relators’ Fourth Amended Complaint” (“Tenet’s Motion to Dismiss”). For the reasons set forth herein, the Government’s Motion to Intervene is GRANTED, the Government’s Motion to Dismiss is DENIED, and Tenet’s Motion to Dismiss is DENIED in part and GRANTED in part.

I. BACKGROUND

The instant case is a qui tam action brought by Doctors William Meshel (“Dr.Meshel”) and Man Tai Lam (“Dr. Lam”) (collectively “Relators”), on behalf of the United States of America (“Government”), against Defendant Tenet Healthcare Corporation (“Tenet”) for alleged violations of the False Claims Act, 31 U.S.C. § 3729 et seq. (“FCA”).

Doctors Meshel and Lam are both licensed physicians who have practiced medicine in El Paso, Texas since 1998 and 1979, respectively. Fourth Am. Compl. ¶¶ 4-5, 8-9 (“FAC”). Throughout their careers, Drs. Meshel and Lam have either maintained privileges and/or held appointments at numerous El Paso area hospitals, including Providence Memorial Hospital (“Providence”), Sierra Medical Center (“Sierra”), and Del Sol Medical Center (“Del Sol”). Id. ¶¶ 8-10. In fact, Dr. Lam served on the Medical Executive Committee of Providence, which is the highest governing body for the medical staff there. 1 Id. ¶ 10.

Tenet operates and maintains both Providence and Sierra. Id. ¶ 7.

*692 Relators allege that, through personal observation and inquiry, they learned that Tenet paid substantial sums to individual physicians to cover the cost of rent, office staff, telephones, and similar business expenses. Id. ¶ 11. They further allege that they learned that Tenet paid physicians for services rendered as “medical directors,” when these physicians did not, in fact, render services in exchange for payment. Id.

In addition to these allegations related to Tenet’s alleged kickback scheme, Rela-tors allege that, by virtue of Dr. Lam’s management positions at Providence and Sierra, Dr. Lam knew that Providence and Sierra were earning substantially higher profits than Southwestern. Third Am. Compl. ¶ 11 (“TAC”). They allege that Dr. Lam knew that Tenet hospitals listed much higher charges on their charge master (the hospital’s published list of fees for various services) than Southwestern, even though the Government generally reimburses a fixed amount for Diagnosis Related Groups (“DRGs”), irrespective of the figure stated on the charge master. Id. Though Dr. Lam had been briefed on the outlier component of the Medicare reimbursement system, he did not immediately recognize how increases in charge master prices affected reimbursement for outliers. Id. ¶ 12.

In January 2002, Relators allegedly met in the Del Sol Hospital physician’s lounge to exchange information regarding Tenet’s practices with respect to medical directorships and high DRG charges. FAC ¶ 12. Both noted the substantially higher profits earned by Tenet facilities in comparison with Southwestern facilities. Id. At this meeting, Dr. Lam allegedly informed Dr. Meshel that he had discovered that Tenet was using the appointment of medical directorships and other payments as a method by which to induce patient referrals. Id. ¶ 13.

After this meeting, Dr. Meshel allegedly proceeded with his own inquiry and reported information to FBI Agent Steve Sylvester on February 17, 2002. Id. ¶ 14. Specifically, Dr. Meshel alleges that on or around February 17, 2002, he provided Agent Sylvester with information regarding how much money the directors of particular services should make, and with information that three oncologists and an infectious disease specialist were receiving kickbacks from Tenet. Id. On February 18, 2002, Dr. Meshel further relayed to Agent Sylvester that Dr. Lam had discovered that four physicians in the Texas Oncology P.A. practice group were receiving kickbacks from Tenet, and that such payments were being identified as expenses on the hospital’s cost reports. Id. ¶ 15. Relators also allege that they provided Agent Sylvester with information related to the high DRG charges around this time. TAC ¶ 15.

Thereafter, on April 16, 2002, Relators allege that Dr. Meshel met with Agents Sylvester, FNU 2 Skillington, and/or FNU Murray to relay the information that he and Dr. Lam had uncovered. FAC ¶ 16. Agent Murray allegedly responded that the case might be difficult to prove because the physicians could claim that they had spent time at home working on matters related to their medical directorships. Id. On this same date, Dr. Meshel also sent Agent Sylvester an email summarizing what he had reported in their meeting. Id. For example, he wrote that Providence and Sierra had been paying five specific physicians in the oncology group between $60,000 and $120,000 per year, an amount much higher than the estimated legitimate pay for a medical director, to induce patient referrals. Id. ¶ 17. Dr. Meshel also *693 informed Agent Sylvester that these five oncologists were referring a large number of patients to Tenet facilities at remote locations, notwithstanding the fact that Del Sol was across the street and had facilities capable of treating all such patients. Id. ¶ 18. In their Fourth Amended Complaint, Relators describe in detail several suspicious referrals. Id. ¶¶ 19-26.

Dr. Meshel alleges that he continued his investigation and reported his findings to Agent Sylvester on an ongoing basis. Id. ¶ 27-28.

On November 18, 2002, Drs. Lam and Meshel filed a qui tarn action on behalf of the United States, alleging two causes of action. First, Relators allege that “Tenet improperly manipulated the [ojutlier system by artificially inflating its charges when its real costs remained constant or even declined,” thereby improperly manipulating payments from the Medicare/Medicaid system. TAC ¶ 31. Second, Relators allege that Tenet developed a “kickback scheme,” whereby it offered remuneration in the form of medical directorships at Tenet and reimbursement of office expenses to physicians who referred patients to Tenet hospitals. FAC ¶ 29. In July 2005, the Government formally indicated its intent not to intervene in the suit. Thereafter, Relators pursued this case on their own.

On June 29, 2006, the United States finalized a global settlement with Tenet, resolving allegations that Tenet had improperly received outlier payments from Medicare and other federal health care programs, among other things. Tenet’s Req. for Judicial Notice, Ex.

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481 F. Supp. 2d 689, 2007 U.S. Dist. LEXIS 28400, 2007 WL 989140, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-lam-v-tenet-healthcare-corp-txwd-2007.