State v. Associated Anesthesiologists of Springfield, Ltd.
| Decision Date | 30 March 2018 |
| Docket Number | NO. 4-17-0336,4-17-0336 |
| Citation | 2018 IL App (4th) 170336 -U |
| Parties | The State of Illinois, ex rel. DONALD HELFER, M.D., Plaintiff-Appellant, v. ASSOCIATED ANESTHESIOLOGISTS OF SPRINGFIELD, LTD., an Illinois Corporation; CBIZ MEDICAL MANAGEMENT PROFESSIONALS, INC., a Former Ohio Corporation; and ANESTHESIA BUSINESS CONSULTANTS, LLC, a Michigan Limited Liability Corporation, Defendants-Appellees. |
| Court | United States Appellate Court of Illinois |
NOTICE
This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances allowed under Rule 23(e)(1).
Appeal from Circuit Court of Sangamon County
Honorable John M. Madonia, Judge Presiding.
¶ 1 Held: The appellate court affirmed, finding the trial court did not err in granting defendants' motions to dismiss.
¶ 2 In October 2014, plaintiff, Donald Helfer, M.D., filed a qui tam action against defendants, Associated Anesthesiologists of Springfield, Ltd. (Associated), CBIZ Medical Management Professionals, Inc. (CBIZ), and Anesthesia Business Consultants, LLC (Business Consultants). The trial court dismissed the complaint due to procedural errors and gave plaintiff leave to refile. After plaintiff filed his second amended complaint, defendants moved to dismiss the complaint. The court granted the motions and dismissed the complaint with prejudice.
¶ 3 On appeal, plaintiff argues the trial court erred by granting the motions to dismiss. We affirm.
¶ 5 Plaintiff was employed as an anesthesiologist for Associated from August 1990 until October 2009. Associated is a group of physicians who contract with Memorial Medical Center (Memorial) in Springfield, Illinois, to supply anesthesia services to Memorial's patients. Associated bills patients' insurance companies or Medicaid for covered anesthesia services. Business Consultants contracts with anesthesia groups like Associated to provide billing, accounts receivable, and business services. In 2008, Business Consultants contracted with Associated to provide those services for various payers such as Medicaid. Part of the contract with Medicaid required Associated to comply with all current and future program policy and billing provisions set forth in the applicable Healthcare and Family Services Medical Assistance Program rules and handbooks, as well as federal standards specified in the Social Security Act (42 U.S.C. § 1396 (1984), 42 U.S.C. § 1397aa-mm (1981)), and be fully liable for the truth, accuracy, and completeness of all claims submitted for payment.
¶ 6 The physicians for Associated work on shift assignments at the hospital. The Associated anesthesiologist "performs medical direction" of anesthesia services for up to four procedures during the majority of his or her work time. When a patient arrives at Memorial for a procedure requiring anesthesia, the anesthesiologist meets with the patient for a preoperative consultation. After the patient is taken into the operating/procedure room, the anesthesiologist is called into the room to direct induction of anesthesia. As allowed by Medicaid regulations, Associated anesthesiologists, generally, do not remain in the operating room throughout the procedure but turn the anesthesia monitoring over to a certified registered nurse anesthetist(CRNA). The Associated anesthesiologist is then free to perform anesthesia services for other patients, until such time as he or she is called to the procedure room for any services which may be required of the anesthesiologist. In fact, physician anesthesiologists perform anesthesia services for up to four surgical patients at one time.
¶ 7 As was noted by defendant, Business Consultants, in its brief, the administration of epidural anesthesia services for patients in labor is not included in the Associated anesthesiologists normal daily surgical schedule. Instead, they are called to the obstetrics ward whenever a pregnant woman presents in labor and is scheduled for the administration of epidural anesthesia. The anesthesiologist then leaves his/her assigned operating room to attend to the patient in labor, start the flow of anesthesia, leave the patient in the care of a qualified nurse, and return to his/her normal duties.
¶ 8 In March 2010, plaintiff filed a claim in the United States District Court for Central Illinois, seeking relief under the federal False Claims Act (31 U.S.C § 3729 (2006)) and Illinois False Claims Act (IFCA) (740 ILCS 175/3(a)(1)(B) (West 2008)), alleging defendants (Associated, CBIZ, and Business Consultants) created fraudulent billing records relating to their continuous epidural anesthesia services, which were submitted by Associated. In August 2014, the district court granted defendants' consolidated motion to dismiss all federal claims for failure to state a claim, except two claims for retaliatory firing against Associated, pursuant to Federal Rule of Civil Procedure 12(b)(6) (Fed. R. Civ. P. 12 (eff. Dec. 9, 2009)). The court declined to exercise supplemental jurisdiction over the state law claims and dismissed the IFCA claims. United States ex rel. Helfer v. Associated Anesthesiologists of Springfield, No. 10-3076 (U.S.D.C., C.D. IL, Springfield Division, August 25, 2014.)
¶ 9 In October 2014, plaintiff filed a qui tam action, which forms the basis of this appeal, alleging defendants violated section 3(a)(1) of the IFCA (740 ILCS 175/3(a)(1) (West 2014)) under the same theory as his federal court claim. Each defendant filed a motion to dismiss pursuant to section 2-615 of the Code of Civil Procedure (Code) (735 ILCS 5/2-615 (West 2016)), alleging failure to state a claim and lack of standing due to the failure of the plaintiff to follow procedural requirements. The trial court granted the motions without prejudice because the court found plaintiff failed to properly follow procedural pleading requirements for initiating a qui tam action, citing failure to notify the State of Illinois of the proceeding, among others. The court also found plaintiff's complaint failed to allege sufficient facts to state a claim against defendants.
¶ 10 Plaintiff filed his first amended complaint in November 2015, and the State of Illinois declined to intervene. Defendants again moved to dismiss the first amended complaint under section 2-615 of the Code, contending the complaint failed to state a claim, and the trial court dismissed the complaint without prejudice, finding plaintiff failed to provide sufficient facts to support the allegations of fraud. In January 2017, plaintiff filed his second amended complaint with a jury demand, which is the subject of this appeal, and the State of Illinois again declined to intervene.
¶ 11 In his second amended complaint, plaintiff alleged defendants committed fraud by not following the "Anesthesia Guidelines" on reporting time set forth in the American Medical Association Current Procedural Terminology (CPT) for continuous epidural anesthesia for childbirth services provided from March 2002 to present. Plaintiff alleged defendants submitted false claims or created false statements indicating an anesthesiologist was present with the obstetric patient during the entire course of the administration of anesthesia, when theanesthesiologist was not in fact physically present during the entire period. According to plaintiff, the anesthesiologists left the patient after beginning the epidural and anesthesia service and did not return, even though the anesthesia administration continued. The complaint asserted Associated submitted claims to Illinois Medicaid for inflated anesthesia time as a result of its continued billing when the anesthesiologist had left the patient before the patient could be safely placed under postoperative supervision. The CPT for 2017 stated, in part, as follows:
We note plaintiff attached annual versions of the CPT's "Anesthesia Guidelines" from 2002 to 2017 to the amended complaint. The language in each version is identical. We have referenced the 2017 version because plaintiff alleges the fraudulent billing occurred from 2002 to the present. In plaintiff's complaint, he contended this provision was a binding obligation on Associated and other defendants to report time for anesthesia services only when the anesthesiologist was in the actual physical presence of the patient. Plaintiff alleged he did not calculate the total anesthesia time, as he was advised CBIZ/Business Consultants would do so. He further alleged the time as reported by CBIZ/Business Consultants was from the time the induction of anesthesia began to the birth of the child. He contended CBIZ knew from the patient's record an Associated anesthesiologist was not physically present for the entire timeanesthesia was being administered to a patient. He also alleged Illinois Medicaid paid Associated for the epidural anesthesia claims submitted.
¶ 12 Defendants moved to dismiss the action pursuant to section 2-615 of the Code (735 ILCS 5/2-615 (West 2016)), contending plaintiff failed to plead facts sufficient to establish (1) how time for continuous epidural services was customarily reported in the local area or, alternatively, (2) defendants improperly billed for time after patients had been safely placed under postoperative supervision. The trial court dismissed the second amended complaint with prejudice. The court found plaintiff did not and could not allege facts sufficient to establish defendants billed for time while patients...
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