Litigation > False Claims Act/Qui Tam Defense > State FCA Resource Center > Maa v. Ostroff
06 May '13

Maa v. Ostroff, Case No. 12-CV-00200-JCS (N.D. Cal. April 19, 2013): The court dismissed a complaint alleging that a doctor and other employees of UCSF Medical Center violated California Insurance Code section 1871.7(b) by presenting false claims to private insurance companies. The plaintiff alleged that the defendants performed medically unnecessary procedures and then billed private insurance companies for those procedures, violating section 1871.7(b). The plaintiff also alleged that the defendants, among other things, submitted claims for such medically unnecessary procedures to Medicare, violating the federal False Claims Act. The court dismissed the complaint in its entirety with leave to amend. It dismissed the plaintiff’s claim under section 1871.7(b) for two separate and independent reasons. First, the court found that the plaintiff failed to allege any unnecessary procedures with the requisite particularity. Second, it found that the plaintiff could not allege a claim under section 1871.7(b) because he did not identify any statute that requires claims submitted to private insurance companies to be medically necessary. The court explained that Penal Code section 550(b) prohibits several types of fraudulent conduct, but “says nothing about medically unnecessary procedures.”