From the monthly archives:

September 2010

Today, the U.S. Supreme Court announced that it was going to hear the sixth False Claims Act case in as many years. In examining this Second Circuit case, U.S. ex rel. Kirk v. Schindler Elevator Company, 601 F.3d 94 (2d Cir. 2009), the Supreme Court will be faced with the issue of whether a federal agency’s response to a Freedom of Information Act request is a “report . . . or investigation” within the meaning of the False Claims Act’s public disclosure bar, 31 U.S.C. § 3730(e)(4).

The Public Disclosure Bar was added to the FCA in 1986, with the twin purposes of encouraging the filing of qui tam actions while still preventing relators from receiving a reward when they merely copy fraud allegations that have already been broadly disseminated to the public. The bar was only intended to apply when the fraud allegations were detailed in the very specific, statutorily defined public disclosures, enumerated in 31 U.S.C. 3730(e)(4)(A).

Over the years, however, some courts have broadly interpreted this list to include disclosures that fall outside of this narrow list. For example, when it comes to the issue now before the Supreme Court, then-Judge Alito penned an opinion in U.S. ex rel. Mistick PBT v. Housing Authority of the City of Pittsburgh, 186 F.3d 376 (3d Cir. 1999), which held that a government employee’s response to a FOIA request qualifies as a governmental “report” under the FCA public disclosure bar.

Other courts have sensibly read the bar to only apply to actual governmental reports, which likely put the government on to the trail of fraud. For example, in U.S. ex rel. Haight v Catholic Healthcare West, 445 F.3d 1147 (9th Cir. 2006), the court took a different approach. Rather than relying on the dictionary definition of the words “report” and “investigation,” the Ninth Circuit looked at the words in the context of the Public Disclosure bar as whole. The Ninth Circuit concluded that construing the terms “report” and “investigation” to refer to work product that represents governmental analysis or leg-work, rather than the mechanistic production of documents that follows upon a FOIA request, is in keeping with the goals of the FCA’s Public Disclosure Bar:

a FOIA request is a mechanism for duplicating records that are in the possession of the federal government and that are not otherwise excludable from members of the public. In contrast, reports and investigations generally involve independent work product. “Report” denotes a document that includes an analysis of findings; “investigation” implies independent governmental leg-work. Moreover, the FCA’s jurisdictional bar groups “report” and “investigation” with a series of other enumerated sources that each involve extensive governmental work product and involvement. Because responding to a FOIA request requires little more than duplication, labeling any response to a FOIA request a “report” or “investigation” would ignore the way in which each of the enumerated sources [in the statute] involves governmental work product.

Id. at 1153 (internal quotation marks and citation omitted).

In Kirk, the Second Circuit agreed with the Ninth Circuit, further dividing the circuits on this issue. The U.S. Supreme Court will now have the ultimate say on this important issue.

For more information about qui tam law and health care fraud, contact Nolan & Auerbach, P.A.

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Companies Are Held Accountable for Fraudster Employees

by Nolan and Auerbach on September 24, 2010

The federal government brought a False Claims Act action against a mortgage company, alleging that it violated the FCA when its employees improperly paid referral fees to a real estate company. The mortgage company argued that it should not be held liable for its employees’ misdeeds, especially since the fraudulent activity was against the company’s penal interests. In United States v. Anchor Mortgage Corp., 2010 WL 3184210 (N.D. Ill. Aug. 11, 2010), the court held that under the theory of respondeat superior, the company can be held liable when its employee was “acting within the scope of employment.” Here, the court found that the employees were acting within the scope of their delegated authority and the employees were clearly acting for the benefit of the mortgage company, “which profited from the transactions” of the increased business.

Corporations are required to maintain a watchful eye over the actions of their employees. Too often, companies turn a blind eye to fraud within their corporate ranks, only to argue that they were oblivious to the fraudulent activity pumping up their soaring profits. Relators are able to hold these companies accountable.

For more information about qui tam law and health care fraud, contact Nolan & Auerbach, P.A.

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A doctor brought a qui tam action, alleging that the owner of several health care businesses had submitted false certifications to Medicare, for the businesses were engaged in the “unlawful corporate practice of medicine” and referrals among the businesses were unlawful. In affirming a lower court’s dismissal of this action, the Ninth Circuit ruled that the relator’s complaint did not spell out the allegations in sufficient detail. See U.S. ex rel. Ebeid v. Lungwitz, 2010 WL 3092637 (9th Cir. Aug. 9, 2010).

Notably, the Ninth Circuit, in rejecting the lower court’s reading of the law, held that the relator does not need to identify representative examples of false claims to support every allegation. Instead, the Court of Appeals ruled that it was sufficient to allege particular details of a scheme to submit false claims, as long as these details were paired with “reliable idicia that lead to strong inference that claims were actually submitted” to the government. The Ninth Circuit found that the relator failed to meet even this standard, for he failed to state which particular laws were violated by the defendant’s activities.

Oftentimes, False Claims Act cases turn on a violation of a controlling law or regulation. It is the job of experienced relator’s counsel to help identify the applicable laws and regulations.

For more information about qui tam law and health care fraud, contact Nolan & Auerbach, P.A.

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A salesman for a medical device manufacturer expressed concerns to his supervisors that the company was illegally marketing its products to physicians. After the company fired the salesman, he brought a lawsuit against the company, alleging retaliatory discharge in violation of the False Claims Act’s anti-retaliation provision. In Smith v. C.R. Bard, Inc., 2010 WL 3122793 (M.D. Tenn. Aug. 9, 2010), the court dismissed the case, ruling that the salesman did not engage in protected activity under the False Claims Act, for his internal complaints did not seek to “expose” fraud on the government.

Narrow readings of the FCA, such as this decision, were the driving force behind several recent FCA amendments. Under the amended False Claims Act, employees who now raise concerns within the confines of the corporation are protected by the FCA’s anti-retaliation provision. Unfortunately, the courts have ruled that these amendments do not apply to cases that were filed prior to the enactment of the amendments.

For more information about qui tam law and health care fraud, contact Nolan & Auerbach, P.A.

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