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Conner v Salina Health Ctr.
10th Circ.
Conner was denied reappointment
to Salina following a peer review panel recommended against the
reappointment. Conner filed suit that he was due federal due process even
though the hospital was private. The district court said it was private
and there were no federal grounds and the hospital was not a state
officer. The 10th Circuit agreed that the plaintiff was deprived of no
federal rights. The court also found that traditionally peer review was
not regulated by the state. |
Conner v. Salina Regional Health Center, Inc. (10th Cir. 2008)
In U.S. ex rel. Conner v. Salina Regional Health Center, Inc., the court
held that if the express certification does not specifically state that
compliance is a prerequisite to payment, the court “must look to the
underlying statutes to surmise if they make the certification a
condition of payment.” The court rejected the notion that a very broad
certification of compliance with all health care laws and regulations
could satisfy the specific requirements of the FCA. Conner alleged that
Salina Regional Health Center (SRHC) submitted false certifications of
compliance in its annual cost reports, in which health care providers
notify the government of over- and under-payments resulting from
Medicare bills submitted throughout the year. The underlying statute
regulating annual cost reports did not expressly condition payment on
the certification of compliance. Instead, Conner asked the court to find
that the compliance certification found in the annual cost report
explicitly conditioned Medicare payments on compliance with all
applicable Medicare statutes and regulations. Conner, 543 F.3d at 1218.
The court explained that this broad interpretation of the certification
requirement could not be reconciled with existing Medicare regulations
and enforcement of the FCA:
Although this certification (appearing on the annual cost report)
represents compliance with underlying laws and regulations, it contains
only general sweeping language and does not contain language stating
that payment is conditioned on perfect compliance with any particular
law or regulation. Nor does any underlying Medicare statute or
regulation provide that payment is so conditioned. Thus, by arguing that
the certification’s language is adequate to create an express false
certification claim, Conner fundamentally contends that any failure by
SRHC to comply with any underlying Medicare statute or regulation during
the provision of any Medicare-reimbursable service renders this
certification false and the resulting payments fraudulent.
Id.at 1219. The court noted that the Medicare statutes have many ways of
enforcing underlying laws and regulations, including a plan of
correction, a reasonable time period to address deficiencies, and the
opportunity to correct billing practices. If, after these conditions are
satisfied, the provider remains substantially noncompliant, Medicare
program participation may eventually be terminated. Conditions of
payment, on the other hand, “are those which, if the government knew
they were not being followed, might cause it to actually refuse
payment.” Id. at 1218–1220. Because the court found that the
certification in SRHC’s cost report related to conditions of
participation, the court held that no false claim had been filed. Id. at
1226.
Link to case law
Legal discussion on his case
Limiting the Scope of the False Claims Act: the Tenth Circuit’s Decision
in United States ex rel. Conner v. Salina Regional
Health Center |
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