Justia U.S. 11th Circuit Court of Appeals Opinion SummariesArticles Posted in Government Contracts
Ruckh v. Salus Rehabilitation, LLC
Relator filed a qui tam action under the False Claims Act (FCA) and the Florida False Claims Act (Florida FCA), against two skilled nursing home facilities, two related entities that provided management services at those and 51 other facilities in the state, and an affiliated company that provided rehabilitation services. The Eleventh Circuit denied the motion to dismiss, holding that relator has sufficiently demonstrated she has constitutional standing and thus the case or controversy requirement is satisfied. Furthermore, relator's entry into the litigation funding agreement does not violate the FCA. Drawing all inferences in favor of relator, the court held that the evidence at trial permitted a reasonable jury to find that defendants committed Medicare-related fraud. In this case, relator alleged that defendants defrauded Medicare through the use of two improper practices: upcoding and ramping. Furthermore, relator introduced sufficient evidence to permit a jury to reasonably conclude that La Vie Management caused the submission of false claims. Therefore, the court reversed the district court's grant of summary judgment as a matter of law to defendants as to the Medicare-related fraud claims. However, the court held that the district court correctly granted defendants' motion for judgment as a matter of law as to the alleged false Medicaid claims where, based on the evidence presented at trial, no jury could have reasonably concluded that defendants defrauded Medicaid. The court remanded with instructions for the district court to reinstate the jury's verdict in favor of relator, the United States, and the State of Florida and against defendants on the Medicare claims in the amount of $85,137,095, and to enter judgment on those claims after applying trebling and statutory penalties. The court also reversed and vacated the district court's grant of a conditional new trial. View "Ruckh v. Salus Rehabilitation, LLC" on Justia Law
Barrientos v. CoreCivic, Inc.
Plaintiffs, current and former alien detainees, filed a class action under the Trafficking Victims Protection Act (TVPA) and Georgia law, alleging that CoreCivic, a private contractor which owns and operates the Stewart Detention Center, coerces alien detainees to perform labor at the detention center by, inter alia, the use or threatened use of serious harm, criminal prosecution, solitary confinement, and the withholding of basic necessities. The Eleventh Circuit affirmed the district court's denial of CoreCivic's motion to dismiss the complaint and held that the TVPA applies to private for-profit contractors operating federal immigration detention facilities. Specifically, the court held that, under the plain language of the statute, the TVPA covers the conduct of private contractors operating federal immigration detention facilities; the TVPA does not bar private contractors from operating the sort of voluntary work programs generally authorized under federal law for aliens held in immigration detention facilities; but private contractors that operate such work programs are not categorically excluded from the TVPA and may be liable if they knowingly obtain or procure the labor or services of a program participant through the illegal coercive means explicitly listed in the TVPA. View "Barrientos v. CoreCivic, Inc." on Justia Law
United States v. Aseracare, Inc.
After three former AseraCare employees alleged that AseraCare had a practice of knowingly submitting unsubstantiated Medicare claims in violation of the False Claims Act, the Government intervened and filed the operative complaint. The Eleventh Circuit held that a clinical judgment of terminal illness warranting hospice benefits under Medicare cannot be deemed false, for purposes of the False Claims Act, when there is only a reasonable disagreement between medical experts as to the accuracy of that conclusion, with no other evidence to prove the falsity of the assessment. However, the court held that the Government should have been allowed to rely on the entire record, not just the trial record, in making its case that disputed issues of fact, beyond just the difference of opinion between experts, existed sufficient to warrant denial of the district court’s post-verdict sua sponte reconsideration of summary judgment on the falsity question. Accordingly, the court affirmed in part and remanded in part. View "United States v. Aseracare, Inc." on Justia Law
Carrel v. AIDS Healthcare Foundation, Inc.
Former employees of the Foundation filed suit under the False Claims Act, alleging that the incentives offered to employees and patients were unlawful kickbacks that rendered false any claims for federal reimbursement. The district court dismissed all but two claims, and later granted summary judgment on the remaining claims. The Eleventh Circuit affirmed and held that the employee exemption to the Anti-Kickback Statute applied to payments that the Foundation made to an employee tasked with referring HIV-positive patients to healthcare services offered by the Foundation. The court also held that the district court correctly dismissed relators' other claims for lack of particularity and that relators waived their argument about amendment. View "Carrel v. AIDS Healthcare Foundation, Inc." on Justia Law
United States v. Cochise Consultancy, Inc.
Relator filed a qui tam action alleging that his employer violated the False Claims Act (FCA), 31 U.S.C. 3729-33, by submitting to the United States false or fraudulent claims for payment. The Eleventh Circuit held, as a matter of first impression, that section 3731(b)(2)'s three year limitations period applies to an FCA claim brought by a relator even when the United States declines to intervene. Because the FCA provides that this period begins to run when the relevant federal government official learns of the facts giving rise to the claim, when the relator learned of the fraud is immaterial for statute of limitations purposes. In this case, it was not apparent from the face of the complaint that relator's claim was untimely where his allegations showed that he filed suit within three years of the date when he disclosed facts material to the right of action to United States officials and within ten years of when the fraud occurred. Therefore, the district court erred in dismissing the complaint, and the court reversed and remanded. View "United States v. Cochise Consultancy, Inc." on Justia Law
Marstettler v. Tilton
Relators filed suit under the False Claims Act (FCA), 31 U.S.C. 3729-30, alleging that MD and others misled the Government by providing material false or incomplete information at two points in the transactional relationship, as well as improprieties between the remaining defendants. The Eleventh Circuit held that the district court must revisit whether the relators alleged facts sufficient to support a theory of implied certification as articulated in Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016). The court also held that the complaint did plead fraud in the inducement, and thus the court remanded so that the district court could reexamine the allegations relating to that theory. View "Marstettler v. Tilton" on Justia Law
Phalp v. Lincare, Inc.
Relators filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, alleging that defendants submitted claims to Medicare without adequate authorization from the relevant Medicare beneficiaries and claims that were the product of unsolicited telemarketing calls to Medicare beneficiaries. The Eleventh Circuit affirmed the district court's grant of summary judgment to defendants with one modification. The court explained that, although the district court applied an erroneous scienter standard, the evidence proffered by relators as to defendants' state of mind with respect to the assignment of benefits forms was insufficient to survive summary judgment under the proper standard. The district court did not err in granting summary judgment as to relators' claims that defendants violated Medicare's unsolicited telephone contact rules. View "Phalp v. Lincare, Inc." on Justia Law
United States v. Everglades College
Relators filed a qui tam suit against Keiser University under the False Claims Act (FCA), 31 U.S.C. 3729-3733, alleging that the University falsely certified compliance with a federal law banning incentive payments to university admissions counselors. After relators appealed a limited trial victory, the United States stepped in and settled the case with Keiser, securing a larger monetary recovery than relators did at trial. On appeal, relators challenged the district court's ruling as to the United States and the district court's subsequent award of reduced attorneys' fees and costs. The Eleventh Circuit affirmed the judgment, holding that the United States did not need to satisfy the good-cause intervention requirement for qui tam actions under 31 U.S.C. 3730(c)(3) because that subsection applies only when the government intervenes for the purpose of actually proceeding with the litigation—not when it is stepping in only for the purpose of settling and ending the case; the proposed settlement was fair, adequate, and reasonable; the district court did not err in declining to compel discovery in this case; and the district court did not abuse its discretion in awarding fees and costs. View "United States v. Everglades College" on Justia Law
United States ex. rel. Saldivar v. Fresenius Medical Care Holdings, Inc.
Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, claiming that Fresenius violated the FCA by billing the government for overfill that it received for no cost—allegedly a violation of the statutes governing Centers for Medicare and Medicaid Services (CMS) billing. The district court granted Fresenius's motion for summary judgment. Because the allegations that are the basis of this complaint were publicly disclosed and relator is not an original source, the court lacks jurisdiction to hear this case. The court did not reach the merits of the motion for summary judgment. Accordingly, the court reversed the district court's grant of summary judgment on the merits and remanded for entry of an order dismissing the case for lack of subject matter jurisdiction. View "United States ex. rel. Saldivar v. Fresenius Medical Care Holdings, Inc." on Justia Law
Osheroff v. Humana Inc.
Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, alleging that healthcare clinics provided, and the Humana defendants either knew of or promoted, a variety of free services for patients and health plan members. Relator alleged that the clinics offered such services without regard for medical purpose or financial need and that the value of the services is more than nominal. The court affirmed the district court's dismissal of the amended complaint with prejudice where, under the prior or amended version of section 3730 of the FCA, relator cannot overcome the public disclosure bar. View "Osheroff v. Humana Inc." on Justia Law