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United States Ex Rel. Oughatiyan v. Ipc Hospitalist Company, Inc.

United States District Court, N.D. Illinois, Eastern Division

February 17, 2015

UNITED STATES OF AMERICA, et al., ex rel. BIJAN OUGHATIYAN, Plaintiffs,
v.
IPC THE HOSPITALIST COMPANY, INC., et al., Defendants.

OPINION AND ORDER

JOAN H. LEFKOW, District Judge.

On September 1, 2009, relator Bijan Oughatiyan filed a qui tam action alleging violations of the False Claims Act ("FCA").[1] (Dkt. 1.) The United States intervened on December 6, 2013. (Dkt. 20.) The government filed a complaint in intervention on June 16, 2014, to recover damages and civil penalties under the FCA as well as under the common law theories of payment by mistake and unjust enrichment. (Dkt. 48.) Defendants filed a joint motion to dismiss or, in the alternative, to sever claims. (Dkt. 50.) For the reasons stated below, defendants' motion is granted in part and denied in part.

BACKGROUND[2]

I. The Parties

IPC The Hospitalist Company, Inc. ("IPC") operates a nationwide physician group practice focused on the delivery of "hospital medicine and related facility-based services." (Dkt. 51 at 3.) Its subsidiaries and affiliates provide medical services to patients in various facilities (usually hospitals) throughout the United States. ( Id. )

Relator Bijan Oughatiyan is a physician who worked for IPC as a hospitalist (a medical professional who specializes in the practice of hospital medicine) from 2003 to 2009. (Dkt. 1 at 3.) The initial complaint alleges that Oughatiyan, concerned with IPC's billing practices, "began collecting billing records from various IPC hospitalists" in order to file the present suit. ( Id. ) The government's intervening complaint builds on Oughatiyan's assertions and alleges that, from January 1, 2003 through the present, IPC and its subsidiaries and affiliates knowingly billed Medicare and Medicaid, and other federal payors (including TRICARE, [3] FEHBP, [4] and the RRB[5]) for higher and more expensive levels of medical service than were actually performed. (Dkt. 48 ("Compl.") ¶ 5.) The government names IPC and twenty-nine subsidiaries and affiliated medical groups in the complaint. The government asks the court to hold defendants jointly and severally liable. ( Id. ¶¶ 247, 250.)

II. Code-Based Billing

IPC, like other physician group practices, is reimbursed for the services it provides to patients covered by government benefit programs. For example, Medicare reimbursements, which make up the heart of the government's complaint, are made according to the Medicare Fee Schedule. ( Id. ¶ 51.) The Fee Schedule is based on the American Medical Association's Current Procedural Terminology ("CPT") codes, which are assigned to different medical services and are designed to facilitate the communication of information on these services among physicians, patients, and organizations. ( Id. ¶¶ 51-52.) Each code corresponds to a different level of service. ( Id. ¶ 52.)

Id. [6] Id. [7 ...


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