United States v. Krizek
United States District Court for the District of Columbia
859 F.Supp. 5 (1994)
Dr. Krizek, a psychiatrist treating elderly and poor Medicare and Medicaid patients, relied on his wife to oversee billing using standardized CPT codes on reimbursement forms. The government alleged the Krizeks committed civil fraud by "up-coding," repeatedly billing a code meant for 45-50 minute psychotherapy sessions (code 90844) when shorter, lower-paying sessions had occurred, and by providing medically unnecessary services. At a bench trial, the court narrowed review to 200 representative claims from seven patients.
Whether a physician violates the False Claims Act if he submits bills for Medicare reimbursement and acts in reckless disregard of their truth or veracity.