False Claims Act Case Alleges Surgery Center Exceeded Licensing Limits


On Monday a case was filed in the Southern District of Florida by a result of a qui tam action by Mark Morsch against Roger Khouri and the Key Biscayne Surgery Center, LLC. The case was filed as a false claims act case regarding claims filed by the Surgery Center to Medicare that were in violation of the license for the center.

According to the complaint. the Key Biscayne Surgery Center was licensed by the state of Florida to have one operating room, zero minor procedure rooms, and two recovery beds. This would limit the number of surgical procedures that could be performed at one time to one. However, the plaintiff accuses the defendants of running two full operating rooms, three minor procedure rooms, and two recovery rooms, leading to a possible total of five procedures being performed at the same time.

The complaint explained that these potential additional procedures were performed above and beyond the license granted to the facility and would therefore be classified as unlicensed procedures, for which Medicare does not remit payment for.

The United States accuses the defendants of deliberately performing unlicensed procedures and knowingly submitting these procedures to Medicare for payment. The United States also accuses the plaintiff of submitting falsified records indicating that the procedures were licensed.