On July 9th, the U.S. Court of Appeals for the Tenth Circuit ruled that medical judgment can no longer be used at the summary judgment stage as a defense in a false claims action against a health-care provider that allegedly billed for medically unnecessary treatments. JGL principal Brian Markovitz provided his thoughts regarding this ruling to Bloomberg BNA in a recent article.
Markovitz, who represents whistleblowers, told Bloomberg Law he thought the court wrote a good common sense opinion and did a good job of describing a false claim.
“Just leaving it up to somebody’s judgment is a bad idea,” he said. “First of all, it lets people lie and insulates them from inappropriate and bad behavior, he added. “They could always claim medical judgment,” Markovitz told Bloomberg Law.
He said a bright line rule that allowed medical necessity as a defense could “lead to all sorts of ills” is a stark warning to providers that they must take their compliance obligations seriously. That includes making sure their doctors are performing medical procedures that are truly necessary, based in part on an assessment of whether they are doing so in a way that is on par with their peers.
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Brian Markovitz is a principal in JGL’s Labor and Employment and Civil Litigation practice groups, and focuses on helping victims who have suffered severe injustices in the workplace. He represents individuals in complex employment litigation and appellate matters involving wrongful termination, retaliation by employers in response to reporting fraud or misconduct and discrimination on the basis on race, gender, age and sexual orientation.