Charles Holzner v. Davita Inc.

facts—namely, that [the service] is needed to diagnose or treat a medical condition,

in accordance with accepted standards of medical practice—that do not exist.” Id.

Holzner’s Fourth Amended Complaint does not contain sufficient facts,

accepted as true, to state a plausible claim of false or fraudulent billing related to

the appellees’ provision of dialysis treatments, the prescription drug Sensipar, or

the prescription drug Renagel. The medical literature on which Holzner relies is

not as definitive as he would have it: it does not establish new guidelines for

practitioners or otherwise compel a change of practice among nephrologists.

Holzner is attempting to use the FCA to force dialysis facilities to reject the

considered opinions of treating nephrologists regarding the need for dialysis

treatments, Sensipar, and/or Renagel based on his reading of the relevant literature.

The allegations of the Fourth Amended Complaint show no more than a

disagreement in clinical judgment. Holzner has not raised a plausible inference that

the nephrologists’ certifications that these interventions are medically necessary—

or appellees’ reliance on those certifications—were false…