We earlier reported on the Oklahoma federal court’s dismissal of a False Claims Act complaint premised on non-physicians obtaining patients’ history of present illness, or HPI. In an unpublished decision, the Tenth Circuit recently affirmed the dismissal on Rule 12(b)(6) grounds.
The Tenth Circuit noted that there was no statute, regulation, or other legal requirement that a patient’s HPI be taken by a physician, which meant that the relator could not prove any form of a legally false claim–either express or implied. The court noted that the defendant clinic never reported who had taken the patients’ HPI to any authority because there was no requirement to do so.
While the complaint alluded that because unqualified personnel had obtained the patients’ HPIs, the clinic was unable to determine whether the treatment services were medically necessary, the complaint failed to actually allege that any patient’s treatment was not medically necessary. The court found that the complaint’s allegations thus failed to state a plausible claim for relief.
