Opinion ID: 2746816
Heading Depth: 2
Heading Rank: 1

Heading: Interim Claim Forms

Text: To obtain Medicare reimbursements for any patient (whether referred or not), the Defendants’ hospitals submit “interim claim forms” to the government as medical services are rendered. The government reimburses the hospitals based on the information provided in the forms. Mastej’s complaint does not identify any specific Medicare claim by date, type of service, or amount for any patient, much less or for any referred patient by one of the ten doctors. Nor does it identify how many patients were so referred during any week or month or year—or how many patients any of the ten named doctors referred. Mastej’s complaint also gives no specifics as to what was billed or collected for the prohibited referrals. In short, there are no allegations about which patients, which interim claims, or which payments. There is only the 16 Case: 13-11859 Date Filed: 10/30/2014 Page: 17 of 41 general allegation that the ten doctors referred patients and Defendants submitted Medicare claims for patients referred by the ten doctors and were paid.