1 FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT UNITED STATES EX REL. STEVEN J. HARTPENCE, Plaintiff-Appellant, v. No D.C. No. 2:08-cv GHK-AGR KINETIC CONCEPTS, INC.; KCI-USA, INC., Defendants-Appellees. UNITED STATES EX REL. GERALDINE GODECKE, Plaintiff-Appellant, v. KINETIC CONCEPTS, INC.; KCI-USA, INC., Defendants-Appellees. No D.C. No. 2:08-cv GHK-AGR OPINION Appeal from the United States District Court for the Central District of California George H. King, Chief District Judge, Presiding Argued and Submitted En Banc March 17, 2015 San Francisco, California
2 2 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS Filed July 7, 2015 Before: Sidney R. Thomas, Chief Judge and Stephen Reinhardt, Alex Kozinski, Kim McLane Wardlaw, William A. Fletcher, Ronald M. Gould, Marsha S. Berzon, Consuelo M. Callahan, Carlos T. Bea, Sandra S. Ikuta and N. Randy Smith, Circuit Judges. Opinion by Judge Bea SUMMARY * False Claims Act The en banc court reversed the district court s dismissal of consolidated civil qui tam suits brought on the government s behalf by Steven Hartpence and Geraldine Godecke under the False Claims Act, alleging that plaintiffs former employer fraudulently claimed reimbursements from Medicare. The court held that there are two, and only two, requirements in order for a whistleblower to be an original source who may recover under the False Claims Act: (1) Before filing the action, the whistleblower must voluntarily inform the government of the facts which underlie the allegations of the complaint; and (2) the whistleblower must have direct and independent knowledge of the allegations underlying the complaint. Abrogating earlier precedent, * This summary constitutes no part of the opinion of the court. It has been prepared by court staff for the convenience of the reader.
3 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 3 Wang ex rel. United States v. FMC Corp., 975 F.2d 1412, 1418 (9th Cir. 1992), the court held that it does not matter whether the whistleblower also played a role in the public disclosure of the allegations that are part of his suit. The court remanded for the district court to consider whether plaintiffs qualified as original sources under the two-part test announced in the opinion. The court also held that the district court erred in its application of the first-to-file bar, which provides that a whistleblower must be the first to file an action seeking reimbursement on behalf of the government based on the fraudulent scheme. The panel concluded that Godecke s second and third claims were based on different material facts than the claims contained in Hartpence s earlier-filed complaint. Thus, they were not precluded by the first-to-file bar. COUNSEL Mark Irving Labaton (argued) and Oren Rosenthal, Isaacs Friedberg & Labaton, Los Angeles, California; Michael A. Hirst, Hirst Law Group, P.C., Davis, California; Patrick J. O Connell, Andrea Dawn Rose, and Jan Soifer, O Connell & Soifer LLP, Austin, Texas, for Plaintiffs-Appellants. Gregory M. Luce (argued), Maya P. Florence, and Colin V. Ram, Skadden, Arps, Slate, Meagher & Flom LLP, Washington, D.C.; Matthew E. Sloan, Skadden, Arps, Slate, Meagher & Flom LLP, Los Angeles, California, for Defendants-Appellees.
4 4 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS OPINION BEA, Circuit Judge: If a whistleblower informs the government that it has been bilked by a provider of goods and services, and that scheme is unmasked to the public, under what conditions can that same whistleblower recover part of what the guilty provider is forced to reimburse the government? We hold today that there are two, and only two, requirements in order for a whistleblower to be an original source who may recover under the False Claims Act: (1) Before filing his action, the whistleblower must voluntarily inform the government of the facts which underlie the allegations of his complaint; and (2) he must have direct and independent knowledge of the allegations underlying his complaint. Abrogating our earlier precedent, we conclude that it does not matter whether he also played a role in the public disclosure of the allegations that are part of his suit. We also hold that the district court erred in its application of the rule that a whistleblower must be the first to file an action seeking reimbursement on behalf of the government based on the fraudulent scheme. OVERVIEW The False Claims Act ( FCA ), 31 U.S.C , prohibits knowingly submitting to the federal government a false or fraudulent claim for payment. 1 As one enforcement 1 The FCA was amended by the Patient Protection and Affordable Care Act, Pub. L. No , 124 Stat. 119 (2010). Although the amendments altered the language we are called upon to interpret today, they do not apply retroactively to actions, like these, which were pending
5 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 5 mechanism, the FCA authorizes private parties, known as relators, to bring civil qui tam suits on the government s behalf against entities who have allegedly defrauded the government. 31 U.S.C. 3730(b)(1). In these suits, the relators seek reimbursement of the defrauded amounts on the government s behalf. Where, as here, the government declines to intervene in the suit, the relator stands to receive between 25% and 30% of any recovery. Id. 3730(d)(2). However, the FCA also includes several provisions that deprive federal courts of subject-matter jurisdiction over certain qui tam actions. These cases concern two such provisions, the public disclosure bar and the first-to-file bar. The public disclosure bar precludes qui tam suits where there has been a public disclosure of the fraud, unless the relator qualifies as an original source of the information. Id. 3730(e)(4). The first-to-file bar precludes civil actions based on complaints which allege the same material facts as an earlier-filed civil complaint. Id. 3730(b)(5); United States ex rel. Lujan v. Hughes Aircraft Co., 243 F.3d 1181, (9th Cir. 2001). In these consolidated qui tam cases, Steven Hartpence and Geraldine Godecke ( Relators ) allege their former employer fraudulently claimed reimbursements from Medicare. After these allegations of Medicare fraud were publicly disclosed, Relators each informed the government of the alleged fraud and then filed separate complaints in district court. Under the at the time the statute was amended. Graham Cnty. Soil & Water Conservation Dist. v. United States ex rel. Wilson, 559 U.S. 280, 283 n.1 (2010). We analyze these cases under the pre-2010 version of the FCA. Unless otherwise specified, all references to the FCA are to the pre-2010 version.
6 6 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS public disclosure bar, the district court lacked jurisdiction over these actions unless Relators qualified as original sources under the FCA. 31 U.S.C. 3730(e)(4). Relying on our existing precedent, the district court held that neither Relator qualified as an original source, because neither had a hand in the public disclosure of the fraud, a requirement we announced in Wang ex rel. United States v. FMC Corp., 975 F.2d 1412, 1418 (9th Cir. 1992). The district court further held that Godecke s complaint was also barred by the first-to-file bar, because her complaint alleged the same material elements of fraud as the complaint Hartpence had filed six months earlier. After a careful review of the statutory text, we overrule Wang as wrongly decided, and we remand for the district court to consider whether Relators qualify as original sources under the two-part test we announce today. Second, we hold that the district court erred in finding Godecke s action barred by the first-to-file bar, because some of Godecke s claims are materially distinct from Hartpence s claims. I. The FCA The FCA authorizes whistleblowing private citizens to file suit after discovering that the federal government has been defrauded. Schindler Elevator Corp. v. United States ex rel. Kirk, 131 S. Ct. 1885, 1889 (2011). As originally enacted, the FCA allowed a relator to bring a qui tam action even if he discovered the fraud merely by reading information already in the public domain. See Wilson, 559 U.S. at In 1943, Congress amended the FCA to bar such parasitic lawsuits by precluding actions based on information already in the government s possession. Id. at 294.
7 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 7 The 1943 amendments had the curious effect of barring a plaintiff from bringing a qui tam action based on information already in the government s possession even where the plaintiff himself was the source of the government s knowledge. See, e.g., United States ex rel. Wis. Dept. of Health & Soc. Servs. v. Dean, 729 F.2d 1100 (7th Cir. 1984). In 1986, Congress overhauled the FCA with a series of key amendments. See Wilson, 559 U.S. at 294. Among other things, Congress jettisoned the government knowledge bar to suit in favor of a new condition, the public disclosure bar. This was an effort to strike the proper balance between encouraging private persons to root out fraud and stifling parasitic lawsuits. Id. at 295. The public disclosure bar deprives district courts of jurisdiction over any action based upon the public disclosure of allegations or transactions concerning the alleged fraud, unless... the person bringing the action is an original source of the information. 31 U.S.C. 3730(e)(4)(A). The FCA provides that, to be an original source, a relator must (1) have direct and independent knowledge of information supporting his claims, and (2) provide the information to the Government before filing an action. Id. 3730(e)(4)(B). In Wang, persuaded by the Second Circuit s interpretation and our own review of the legislative history of the 1986 amendments, we held that a relator must meet a third requirement to qualify as an original source: he must have had a hand in the public disclosure of allegations that are a part of [his] suit. 975 F.2d at The 1986 amendments implemented another jurisdictional bar, the first-to-file bar, which prohibits anyone other than the government from intervening or bringing a related action based on the facts underlying [a] pending action. 31 U.S.C. 3730(b)(5). The first-to-file bar prohibits later-filed actions
8 8 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS based on the same material facts as an earlier action. Lujan, 243 F.3d at Unlike the public disclosure bar, the first-to-file bar is exception-free. Id. at II. The Complaints Kinetic Concepts, Inc. and KCI USA, Inc. (collectively, Defendants or KCI ) manufacture medical devices to speed the healing of wounds, using various technological innovations. One such innovation is Vacuum Assisted Closure ( V.A.C. ) Therapy. V.A.C. devices perform negative-pressure wound therapy ( NPWT ), which promotes healing by applying sub-atmospheric pressure to the site of a wound. Since 2000, the Medicare program has covered NPWT devices as durable medical equipment. As the district court explained: The coverage criteria for NPWT devices are found in Local Coverage Determinations ( LCDs ), which are issued by private claims processing contractors known as Durable Medical Equipment Medicare Administrative Contractors ( DME MACs ). There are four separate DME MACs that serve the United States. Because the DME MACs are organized regionally, each DME MAC issues its own LCD for its respective region of the country. In the case of NPWT, the four regional DME MACs have issued separate, but nearly identical, LCDs. When a supplier of NPWT therapy, such as KCI, submits a claim for reimbursement to Medicare, the claim is initially reviewed by
9 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 9 one of the DME MACs in a process known as initial determination. If the DME MAC concludes that a particular claim satisfies its payment criteria, the DME MAC may reimburse the claim. If the DME MAC denies reimbursement of a claim the supplier may appeal that denial through a statutorily authorized administrative appeals process administered by the Secretary of the U.S. Department of Health and Human Services. United States ex rel. Hartpence v. Kinetic Concepts, Inc., No. CV GHK, 2012 WL , at *1 (C.D. Cal. Jan. 30, 2012) (citations omitted). During the course of their employment by Defendants, Hartpence and Godecke allegedly discovered that KCI engaged in fraudulent conduct by submitting claims to Medicare that did not comply with the DME MACs local coverage determinations. The substance of the fraud they claim KCI perpetrated was laid out in their respective district court complaints. Hartpence, who served as KCI s Senior Vice President of Business Systems until July 2007, filed his initial complaint in district court on March 20, As relevant here, his operative complaint 2 alleges that KCI violated the FCA by knowingly misusing what is known as the KX modifier. This is a billing code that certified (allegedly falsely) to Medicare s automated processing system that KCI had records to show that [the] V.A.C. claim 2 Relators each amended their original complaints. For purposes of determining jurisdiction, we look to the allegations in the amended complaints. Rockwell Int l Corp. v. United States, 549 U.S. 457, (2007).
10 10 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS billed for met all... criteria, and that Medicare did not need to look for additional data. Hartpence alleges that KCI improperly submitted claims with the KX modifier: (1) when there was no wound improvement in the previous month; (2) for the treatment of wounds for which V.A.C. therapy was neither reasonable nor necessary; (3) when the required wound measurement documentation was absent; (4) for wounds that had been improving even without V.A.C. therapy; (5) falsely claiming that there had been wound improvement when in fact there was none; and (6) for treatment of wounds that were too small to require V.A.C. therapy. Moreover, Hartpence claims that KCI committed a separate FCA violation by retaining overpayments it obtained as a result of these schemes. Godecke, who served as KCI s Director of Medicare Cash and Collections until October 2007, filed her initial complaint on September 29, 2008, six months after Hartpence s filing. Her operative complaint alleges first that KCI violated the FCA by knowingly misusing the KX modifier in submitting claims for a full month of V.A.C. therapy, even when the therapy that had been stopped and restarted within the same month. 3 As a separate violation, Godecke alleges that KCI ignored the requirement to receive correct and completed Detailed Written Orders ( DWOs ) before delivering supplies and beginning therapy. 4 Third, Godecke alleges that KCI 3 Under this practice, KCI would bill for patients who started V.A.C. therapy on day 1, stopped on day 3 and started again on day 28. KCI would bill for an entire month of service and then would continue to bill for subsequent months. 4 Suppliers of durable medical equipment must obtain DWOs from a patient/beneficiary s treating physician before dispensing supplies for which they seek reimbursement from Medicare. See CMS Manual
11 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 11 improperly retained overpayments it received as a result of these two schemes. In addition to her qui tam claims, Godecke added a retaliation claim that is not at issue on this appeal. III. Procedural History Both complaints were initially filed under seal to allow the government time to review the complaints and decide whether to intervene. See 31 U.S.C. 3730(b)(2). The complaints were unsealed after the government declined to intervene in each case. Defendants then filed a motion to dismiss the complaints for lack of jurisdiction under Federal Rule of Civil Procedure 12(b)(1), asserting that (1) the allegations of Medicare fraud had been publicly disclosed, implicating the public disclosure jurisdictional bar, and (2) Relators did not qualify as original sources. The district court granted the Rule 12(b)(1) motions in each case. 5 The district court held that (1) there had been public disclosures of KCI s alleged V.A.C.-related Medicare fraud in the form of a 2007 federal audit report and at least one decision by an Administrative Law Judge ( ALJ ), and (2) Relators failed to System, Pub , Medicare Program Integrity Manual, Ch. 5, Defendants also filed motions to dismiss the complaints for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6) in each case. Because it granted the Rule 12(b)(1) motions, the court denied the Rule 12(b)(6) motions as moot, except as to Godecke s retaliation claim, which was beyond the scope of the Rule 12(b)(1) motion. United States ex rel. Godecke v. Kinetic Concepts, Inc., No. CV GHK, 2012 WL , at *10 15 (C.D. Cal. Jan. 30, 2012). The district court denied Defendants Rule 12(b)(6) motion on the merits as to Godecke s retaliation claim, and that ruling is not at issue on appeal.
12 12 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS qualify as original sources because they had not shown that they had a hand in those public disclosures. Hartpence, 2012 WL , at *3 8; Godecke, 2012 WL , at *3 8. The district court further held that, even if Godecke s qui tam claims were not barred by the public disclosure bar, her claims would be barred by the first-to-file bar, because they were no more than a slight... variation on Hartpence s earlier-filed claims. Godecke, 2012 WL , at *9. The district court did not address the other two elements of the original source exception (whether proper pre-filing disclosure had been made by Hartpence and Godecke to the federal government and whether Hartpence and Godecke had direct and independent knowledge of KCI s fraud). On appeal, Relators do not challenge the district court s determination that the 2007 federal audit report and at least one ALJ decision constitute public disclosures under the FCA. Rather, they contend that the district court erred when it determined that neither Relator qualified under the original source exception because neither had a hand in the public disclosure, Wang, 975 F.2d at They argue that the hand-in-the-public-disclosure rule is found nowhere in the statutory language. Godecke further argues that her claims are not precluded by the first-to-file bar, because they are sufficiently distinct from the claims asserted by Hartpence. The original three-judge panel sua sponte called for this case to be heard en banc to review Wang s continued validity.
13 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 13 DISCUSSION I. Jurisdiction and Standard of Review We have jurisdiction under 28 U.S.C We review de novo the district court s interpretation of the FCA and its decision to dismiss for lack of subject-matter jurisdiction. Lujan, 243 F.3d at Where the district court relied on findings of fact to draw its conclusions about subject-matter jurisdiction, we review those factual findings for clear error. Id. II. Analysis A. Original Source Exception The public disclosure bar and original source exception that govern these lawsuits read, in full: (A) No court shall have jurisdiction over an action under this section based upon the public disclosure of allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government Accounting Office report, hearing, audit, or investigation, or from the news media, unless the action is brought by the Attorney General or the person bringing the action is an original source of the information. (B) For purposes of this paragraph, original source means an individual who has direct and independent knowledge of the
14 14 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS information on which the allegations are based and has voluntarily provided the information to the Government before filing an action under this section which is based on the information. 31 U.S.C. 3730(e)(4)(A) (B). We previously interpreted the requirements of the original source exception in Wang, 975 F.2d There, we affirmed the dismissal of a suit brought by an engineer against his former employer under the FCA. Because the relator s suit was based on allegations already in the public domain, which triggered the public disclosure bar in 31 U.S.C. 3730(e)(4)(A), jurisdiction turned on whether the relator was an original source. In Wang, we adopted a three-part test to determine whether a plaintiff is an original source: (1) he must have direct and independent knowledge of the information on which his allegations are based; (2) he must have voluntarily provided that information to the government before filing his lawsuit; and (3) he must have had a hand in the public disclosure of allegations that are a part of [his] suit. 975 F.2d at Although the first two requirements parallel the statutory language, we inferred the third requirement from the FCA s legislative history, which suggested to us that the information referenced in the phrase original source of the information, 31 U.S.C. 3730(e)(4)(A), meant the information underlying the publicly disclosed allegations that triggered the public disclosure bar, rather than the information which underlay the plaintiff s complaint. Id. at We were also persuaded by the Second Circuit s similar interpretation of the original source exception in United States ex rel. Dick v. Long Island Lighting Co., 912 F.2d 13 (2d Cir. 1990). In
15 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 15 Dick, the Second Circuit concluded that, to qualify as an original source, a relator must have directly or indirectly been a source to the entity that publicly disclosed the allegations on which a suit is based. Id. at 16. We then found that Wang did not qualify as an original source, because he did not have a hand in the public disclosure of [the] allegations of fraud. Wang, 975 F.2d at Wang has been the law of this circuit for 23 years. As an en banc court, however, we have the authority and, indeed, the obligation to review whether Wang was correctly decided. See Hart v. Massanari, 266 F.3d 1155, 1171 (9th Cir. 2001) ( Once a panel resolves an issue in a precedential opinion, the matter is deemed resolved, unless overruled by the court itself sitting en banc, or by the Supreme Court. ). We note that many of our sister circuits have declined to adopt Wang s third prong the hand-in-the-public-disclosure requirement finding that it impermissibly grafts onto the statute a requirement nowhere to be found in the statute s text. See, e.g., Minn. Ass n of Nurse Anesthetists v. Allina Health Sys. Corp., 276 F.3d 1032, 1048 n.11 (8th Cir. 2002) (finding that the rule we announced in Wang has no basis in the statutory language and we therefore decline to adopt it ); United States ex rel. Siller v. Becton Dickinson & Co., 21 F.3d 1339, 1355 (4th Cir. 1994) ( Accordingly, we hold that a qui tam plaintiff need not be a source to the entity that publicly disclosed the allegations on which the qui tam action is based in order to be an original source[....] ). Today, we join our sister circuits; after reviewing the statutory text, we conclude that Wang s hand-in-the-public-disclosure requirement has no textual basis, and we give it a respectful burial.
16 16 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS In construing the provisions of a statute, we begin by looking at the language of the statute to determine whether it has a plain meaning. BedRoc Ltd. v. United States, 541 U.S. 176, 183 (2004). The preeminent canon of statutory interpretation requires us to presume that the legislature says in a statute what it means and means in a statute what it says there. Thus, our inquiry begins with the statutory text, and ends there as well if the [statute s] text is unambiguous. Id. Where the statute s language is plain, we do not consider the legislative history or any other extrinsic material. Kwai Fun Wong v. Beebe, 732 F.3d 1030, 1042 (9th Cir. 2013) (en banc) (internal quotation marks omitted). On its face, the original source exception has two, and only two, requirements. An original source is an individual who  has direct and independent knowledge of the information on which the allegations are based and  has voluntarily provided the information to the Government before filing an action... based on the information. 31 U.S.C. 3730(e)(4)(B). As Appellee s counsel forthrightly admitted at oral argument, this text contains no requirement that the relator have had a hand in the public disclosure of the fraud. Nor do we detect any ambiguity about the existence of such a requirement that might prompt us to examine extrinsic material. See Kwai Fun Wong, 732 F.3d at Thus, we hold that where an FCA claim has been publicly disclosed before a relator filed his complaint, the relator may bring a qui tam suit if he can show that (1) he has direct and independent knowledge of the information on which the allegations in his court-filed complaint are based and (2) he has voluntarily provided the information to the Government before filing his civil action. 31 U.S.C. 3730(e)(4)(B). He need not have played any role in making the disclosure public.
17 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 17 The Supreme Court s decision in Rockwell International Corp. v. United States lends further support to our interpretation. 6 In Rockwell, the Court asked: [D]oes the phrase information on which the allegations are based [in 31 U.S.C. 3730(e)(4)(B)] refer to the information on which the relator s allegations are based or the information on which the publicly disclosed allegations that triggered the public-disclosure bar are based? Rockwell, 549 U.S. at 470. The Court concluded that the information to which subparagraph (B) speaks is the information upon which the relators allegations are based.... Surely the information one would expect a relator to provide to the Government before filing an action... based on the information is the information underlying the relator s claims. Id. at This excerpt from Rockwell stands in serious tension with the hand-in-the-public disclosure requirement this court adopted in Wang. In Wang, we surmised that the term information in 31 U.S.C. 3730(e)(4)(A) refers to the information underlying the publicly disclosed allegations, not the information underlying the relator s complaint. 975 F.2d at Given the Supreme Court s teaching in Rockwell that information in 31 U.S.C. 3730(e)(4)(B) refers to the 6 Relators argue at length that Rockwell abrogated Wang. Other courts have concluded that Rockwell demands relators to meet two, and only two, requirements to qualify as original sources. See, e.g., United States ex rel. Davis v. District of Columbia, 679 F.3d 832 (D.C. Cir. 2012); United States v. Huron Consulting Grp., 843 F. Supp. 2d 464 (S.D.N.Y. 2012), aff d, 567 F. App x 44 (2d Cir. 2014) (unpublished). We continued to treat Wang as the law of this circuit even after Rockwell. See United States ex rel. Meyer v. Horizon Health Corp., 565 F.3d 1195, 1202 (9th Cir. 2009). We need not decide today whether Rockwell abrogated Wang, because we overrule Wang as wrongly decided. We also overrule Meyer to the extent that it reaffirmed the test we announced in Wang.
18 18 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS information underlying the relator s complaint, Wang s premise is viable only if the same word, information, means something different in the two subsections. We decline to countenance an interpretation of a single word so divorced from its statutory surroundings. See Montero-Martinez v. Ashcroft, 277 F.3d 1137, 1142 (9th Cir. 2002) (noting that, where Congress uses the same word multiple times in the same statute, we presume it has the same meaning each time Congress uses it ). We also note that Rockwell strongly favors an interpretation that imports the same meaning to the word information in both subsections. See Rockwell, 549 U.S. at 472 (suggesting that the word information in 31 U.S.C. 3730(e)(4)(A) and 31 U.S.C. 3730(e)(4)(B) are one and the same, viz., information underlying the allegations of the relator s action ). And, Rockwell makes clear that Congress did not intend to link original-source status to information underlying the public disclosure. Id. We pause to address Appellee s argument that our interpretation is inconsistent with an overarching goal of the False Claims Act to encourage private citizens to uncover fraud, not simply to report it. See, e.g., Wilson, 559 U.S. at 295. But the FCA also aims to incentivize persons with firsthand knowledge of fraud to report it to the government and to prosecute cases against the offending entities, in a sense acting as private Attorneys General. We think it entirely reasonable that Congress sought to reward those who assume responsibility for prosecuting, on the government s behalf, fraud claims about which they have direct and independent knowledge, even if they were not in the chain that caused the public disclosure of the fraud. Yet even if we thought that Congress struck the wrong balance, whom to reward and what actions to incentivize are considerations for Congress,
19 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS 19 when enacting the Act, not for the judiciary. Indeed, if Congress s plain words like those contained in 31 U.S.C. 3730(e)(4) are to have any effect at all, they surely cannot give way to whatever broad goals we, as the judiciary, might prefer. We conclude that Wang impermissibly drew on language from 31 U.S.C. 3730(e)(4)(A) to read a nonexistent, extratextual third requirement into 3730(e)(4)(B). We overrule it as wrongly decided. In this case, the district court concluded that neither Relator qualified as an original source on the sole basis of the hand-in-the-public-disclosure requirement that we now repudiate. The district court did not consider whether Relators met the first (and now the only) two requirements of the original source test: that they have direct and independent knowledge of the information on which their allegations are based and that they voluntarily provide that information to the Government before filing suit. We remand so that the district court may make this determination in the first instance. B. First-to-File Bar The district court concluded that, even if Relators qualified as original sources, Godecke s claims would be precluded by the first-to-file bar. Godecke, 2012 WL , at *9. Because this is a legal determination that did not rest on factual findings, we review de novo. See Campbell v. Redding Med. Ctr., 421 F.3d 817, 820 (9th Cir. 2005). On appeal, Godecke does not contest the district court s conclusion that her first qui tam claim is precluded by the first-to-file bar; it overlaps with Hartpence s claims, which all
20 20 U.S. EX REL. HARTPENCE V. KINETIC CONCEPTS relate to misuse of the KX modifier. Godecke points out, however, that her second and third claims relate to violations of a different Medicare program requirement the requirement that a supplier receive Detailed Written Orders before delivering a V.A.C. pressure wound pump. Godecke argues that she is the first to file on the claims addressing the lack of DWOs and the resulting receipt of improper overpayments. We agree. The first-to-file bar provides: When a person brings an action under this subsection, no person other than the Government may intervene or bring a related action based on the facts underlying the pending action. 31 U.S.C. 3730(b)(5). We treat the first-to-file bar as jurisdictional. Lujan, 243 F.3d at We have clarified that the facts underlying the later-filed complaint need not be identical to those underlying the earlier-filed complaint for the later complaint to be barred. Id. at We reasoned: Limiting 3730(b)(5) to only bar actions with identical facts would be contrary to the plain language and legislative intent: (1) using a narrow jurisdictional bar, such as an identical facts test, would decrease incentives to promptly bring qui tam actions; (2) multiple relators would expect a recovery for the same conduct, thereby decreasing the total amount each relator would potentially receive and incentives to bring the suit; and (3) a narrow identical facts bar would encourage piggyback claims, which would have no additional benefit for the government...
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FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT JOHN FAULKNER, on behalf of himself and all others similarly situated, Plaintiff-Appellant, v. ADT SECURITY SERVICES, INC.; ADT SECURITY
PLEASE NOTE: Legislative Information cannot perform research, provide legal advice, or interpret Maine law. For legal assistance, please contact a qualified attorney. Be it enacted by the People of the
JUNE 2015 COMMENTARY Supreme Court Affirms Narrow Scope of Wartime Suspension of Limitations Act, Interprets False Claims Act First to File Rule In a unanimous decision issued on May 26, 2015, the United
FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE FEDERAL CIVIL FALSE CLAIMS ACT The federal civil False Claims Act, 31 U.S.C. 3729, et seq., ( FCA ) was originally enacted in 1863 to combat fraud perpetrated
Current Issues in Qui Tam Litigation in the Energy Industry Michael L. Beatty BEATTY & WOZNIAK, P.C. March 10, 2006 2 What is the False Claim Act? A False Claim Act case (or qui tam action) allows a private
VNSNY CORPORATE DRA Policy TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005: POLICY REGARDING THE DETECTION & PREVENTION OF FRAUD, WASTE AND ABUSE AND APPLICABLE FEDERAL AND STATE LAWS APPLIES TO: VNSNY ENTITIES
November 9, 2006 Deficit Reduction Act Employee Information Requirements The Deficit Reduction Act ( DRA ) requires states participating in the Medicaid program to amend their State Plans to mandate that
FILING QUI TAM ACTIONS AND FALSE CLAIMS LITIGATION REPRINTED FROM: CORPORATE DISPUTES MAGAZINE JUL-SEP 2015 ISSUE corporate CDdisputes Visit the website to request a free copy of the full e-magazine Published
33 U.S.C. 3729-33 FALSE CLAIMS ACT STATUTORY LANGUAGE 31 U.S.C. 3729. False claims (a) LIABILITY FOR CERTAIN ACTS. (1) IN GENERAL. Subject to paragraph (2), any person who (A) knowingly presents, or causes
VOL. 34, NO. 4 SPRING 2009 Employee Relations L A W J O U R N A L Split Circuits Does Charging Party s Receipt of a Right-to-Sue Letter and Commencement of a Lawsuit Divest the EEOC of its Investigative
Federation of Tax Administrators 2012 Annual Meeting Washington, D.C. June 17-20, 2012 Jordan Goodman - Horwood Marcus & Berk Jack Trachtenberg - Sutherland Whistleblower Developments Federal Court & Qui
UNITED STATES COURT OF APPEALS FOR THE TENTH CIRCUIT FILED United States Court of Appeals Tenth Circuit October 20, 2010 Elisabeth A. Shumaker Clerk of Court LORRIE LOGSDON, Plaintiff Appellant, v. TURBINES,
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT RICHARD REYES, as an individual and on behalf of all others similarly situated, Plaintiff-Appellee, v. DOLLAR TREE STORES, INC., a corporation,
Case: 10-10823 Date Filed: 10/13/2010 Page: 1 of 7 [PUBLISH] CARLOS SHURICK, IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT No. 10-10823 Non-Argument Calendar D.C. Docket No. 6:07-cv-01974-GAP-GJK
When Trusted Counsel Turns Whistleblower Laura Laemmle-Weidenfeld Patton Boggs LLP Washington, DC email@example.com Health care providers have long appreciated the irony that by conducting an
RECOMMENDED FOR FULLTEXT PUBLICATION Pursuant to Sixth Circuit Rule 206 File Name: 05a0162p.06 UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT UNITED STATES ex rel. LOUIS F. GILLIGAN; GREGORY M. UTTER,
Qui Tam actions and the Civil False Claims Act Glenn V. Whitaker Vorys, Sater, Seymour and Pease LLP April 25, 2007 What is Prohibited? Four most common liability provisions (31 U.S.C. 3729): (a)(1) Direct
ELBERT KIRBY, JR.; CALEB MEADOWS, FILED United States Court of Appeals UNITED STATES COURT OF APPEALS Tenth Circuit TENTH CIRCUIT February 5, 2016 Elisabeth A. Shumaker Clerk of Court v. Plaintiffs - Appellants,
Page 1 of 12 I. PURPOSE The purpose of this policy is to comply with the requirements in Section 6032 of the Deficit Reduction Act of 2005 (the DRA ), which amends Section 1902(a) of the Social Security
IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF TENNESSEE NASHVILLE DIVISION ROBERT WHIPPLE ) ) v. ) NO. 3-11-0206 ) JUDGE CAMPBELL CHATTANOOGA-HAMILTON ) COUNTY HOSPITAL AUTHORITY ) MEMORANDUM
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CHRISTOPHER AYDEN BREWSTER, individually, Plaintiff-Appellant, v. SUN TRUST MORTGAGE, INC., Defendant, No. 12-56560 D.C. No. 3:12-cv-00448-
Page 291 TITLE 31 MONEY AND FINANCE 3730 and consistency and to eliminate unnecessary words. The words officer or employee of the Government or a member of an armed force are substituted for officer in
Policy/Procedure Department Administration Effective 08/15/2008 Scope Organization Cross Reference Review Date 08/14/2008,12/18/2013 Revision History Signatures Date 12/18/2013 Prepared by Lavonda Cravey
Pharmacy Fraud, Waste and Abuse Policy 1.0 Compliance Assurance This Fraud Waste and Abuse Policy ( Policy ) reiterates the commitment of this pharmacy to comply with the standards of conduct established
UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY DEAN SMITH, on behalf of himself and Others similarly situated, v. Michael Harrison, Esquire, Plaintiff, Defendant. OPINION Civ. No. 07-4255 (WHW) Walls,
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT UNITED STATES OF AMERICA, Plaintiff-Appellee, v. MAYEL PEREZ-VALENCIA, AKA Santos Irizarry Castillo, AKA Miguel Martinez, AKA Miguel
Case :0-cv-00-EHC Document Filed 0/0/0 Page of 0 PETER D. KEISLER Assistant Attorney General DANIEL KNAUSS United States Attorney THEODORE C. HIRT Assistant Branch Director Civil Division, Federal Programs
Procedure 1910 Responsible Office: Yale Medical Group Effective Date: 01/01/2007 Responsible Department: Administration Last Revision Date: 09/20/2013 Prevention of Fraud, Waste and Abuse Policy Statement...
False Claims Act Update Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: firstname.lastname@example.org KD_4901979 1 The FCA is the Fraud Enforcement
FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS 1) Federal False Claims Act (31 USC 3729-3733) II. NEW YORK STATE LAWS A. CIVIL AND ADMINISTRATIVE LAWS 1) New York False Claims
In the Missouri Court of Appeals Western District STEVE AUSTIN, Appellant, v. JOHN SCHIRO, M.D., Respondent. WD78085 OPINION FILED: May 26, 2015 Appeal from the Circuit Court of Clinton County, Missouri
BILL ANALYSIS Senate Research Center C.S.S.B. 1309 By: Wentworth Jurisprudence 4/5/2007 Committee Report (Substituted) AUTHOR'S / SPONSOR'S STATEMENT OF INTENT C.S.S.B. 1309 gives the State of Texas civil
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Type: MGI Corporate Policy Number: M 700 Effective Date: June 2014 Supersedes: AP 201, 4/12 Revised: 6/14 EDUCATION ABOUT FALSE CLAIMS RECOVERY I. PURPOSE This policy is intended to ensure compliance with
Case: 14-13724 Date Filed: 12/30/2015 Page: 1 of 11 [PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT No. 14-13724 D.C. Docket No. 9:13-cv-81259-RNS GLENAAN ROBBINS, individually
SB2730 TESTIMONY OF THE DEPARTMENT OF THE ATTORNEY GENERAL TWENTY-SIXTH LEGISLATURE, 2012 ON THE FOLLOWING MEASURE: S.B. NO. 2730, RELATING TO FALSE CLAIMS TO THE STATE. BEFORE THE: SENATE COMMITTEE ON
Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Appellate Division In the Case of: The Physicians Hospital in Anadarko, Petitioner, - v. - Centers for Medicare & Medicaid Services. DATE:
OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS POLICY: CC-109 It is the policy of OSF HealthCare (OSF) that false, inaccurate or improper claims will not be submitted to any payer.
Portfolio Media. Inc. 860 Broadway, 6th Floor New York, NY 10003 www.law360.com Phone: +1 646 783 7100 Fax: +1 646 783 7161 email@example.com Lessons From Omnicare Settlement In 'Swapping' Cases
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT KATHRYN MCOMIE-GRAY, Plaintiff-Appellant, No. 10-16487 v. D.C. No. 2:09-cv-02422- BANK OF AMERICA HOME LOANS, FKA Countrywide Home Loans,
UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 14-1944 THE TRAVELERS INDEMNITY COMPANY OF AMERICA, v. Plaintiff Appellant, PORTAL HEALTHCARE SOLUTIONS, L.L.C., Defendant Appellee.
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT JOEL JOHNSON, a single person, Plaintiff-Appellant, v. FEDERAL HOME LOAN MORTGAGE CORPORATION, a foreign corporation, Defendant-Appellee.
REFERENCE TITLE: state false claims actions State of Arizona House of Representatives Fiftieth Legislature Second Regular Session HB Introduced by Representative Patterson AN ACT AMENDING TITLE, ARIZONA
LAST CALL: ACCORDING FIRST-FILED QUI TAM COMPLAINTS GREATER PRECLUSIVE EFFECT UNDER BATISTE S NARROW INTERPRETATION OF THE FIRST-TO-FILE RULE Abstract: On November 4, 2011, in United States ex rel. Batiste
The False Claims Act: A Primer The False Claims Act (FCA), 31 U.S.C. 3729-3733 was enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding
A New Practitioner s Guide to the Federal False Claims Act Brave New World Recent Developments in Federal and State False Claims Act Litigation Harry Litman Litman Law Firm & Phillips & Cohen LLP firstname.lastname@example.org
DEVELOPMENTS IN QUI TAM WHISTLEBLOWER SUITS September 15, 2011 Daniel M. McClure Fulbright & Jaworski L.L.P. Houston, Texas email@example.com 77185431 1 QUI TAM Qui Tam Pro Domino Rege Quam Pro Se
CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656 12650. (a) This article shall be known and may be cited as the False Claims Act. (b) For purposes of this article: (1) "Claim" includes any
IN THE UNITED STATES DISTRICT COURT EASTERN DISTRICT OF ARKANSAS WESTERN DIVISION PAM HOWARD and EBEN HOWARD ex rel UNITED STATES OF AMERICA PLAINTIFFS v. No. 4:13CV00310 JLH ARKANSAS CHILDREN S HOSPITAL;
The Nuances Of California s Revisions To Its False Claims Act by Regina A. Verducci, Associate Watt, Tieder, Hoffar & Fitzgerald, L.L.P.* On September 27, 2012, California s Governor Brown signed Assembly
As amended by Chapter 16 of the 2013 Minnesota Session Laws. 15C.01 DEFINITIONS MINNESOTA FALSE CLAIMS ACT Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings
FOR IMMEDIATE NEWS RELEASE NEWS RELEASE # 15 FROM: CLERK OF SUPREME COURT OF LOUISIANA The Opinions handed down on the 26th day of February, 2008, are as follows: PER CURIAM: 2007-CC-1091 FREY PLUMBING
OVERVIEW OF FALSE CLAIMS ACT Robert C. Bundy, Esq. 1034 W. 4 th Avenue, Suite 600 Anchorage, AK 99501 907.257.7853 OVERVIEW OF FALSE CLAIMS ACT A. Background. The False Claims Act (FCA), 31 U.S.C. 3729-3733
STATE OF MINNESOTA IN COURT OF APPEALS A13-1302 Robert Meeker, et al., Appellants, vs. IDS Property Casualty Insurance Company, Respondent. Filed April 21, 2014 Reversed and remanded Peterson, Judge Wright
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT DONALD LYLE STRATTON, Plaintiff-Appellant, v. JULIE BUCK, in her individual capacity; DALE BROWN, in his individual capacity; JOHN DOE,
No. 03-50538 IN THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT CHRISTIAN M. RANDOLPH, v. Plaintiff-Appellant, TEXAS REHABILITATION COMMISSION, (MARY) ESTER DIAZ, LARRY ANDERSON, ELIZABETH GREGOWICZ,
Notice: This opinion is subject to formal revision before publication in the Atlantic and Maryland Reporters. Users are requested to notify the Clerk of the Court of any formal errors so that corrections
Minnesota False Claims Act Minnesota Stat. 15C.01 to 15C.16) 15C.01 DEFINITIONS Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim.
ADMINISTRATIVE ASSESSMENT OF CIVIL PENALTIES AGAINST FEDERAL AGENCIES UNDER THE CLEAN AIR ACT The Clean Air Act authorizes the Environmental Protection Agency administratively to assess civil penalties
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION BARBARA DICKERSON, et al., Plaintiffs, v. No. 4:03 CV 341 DDN DEACONESS LONG TERM CARE OF MISSOURI, INC., Defendant. MEMORANDUM
The Impact of the PPACA on Fraud and Abuse Issues American Bar Association May 5, 2010 Kirk Ogrosky, Arnold & Porter LLP Lisa M. Ohrin, Katten Muchin Rosenman LLP Donald H. Romano, Arent Fox LLP The Patient
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT UNITED STATES OF AMERICA, Plaintiff-Appellee, v. JOHN R. MALONEY, Defendant-Appellant. No. 11-50311 D.C. No. 3:10-cr-02803-DMS-1 ORDER
Case 1:07-cv-01227 Document 37 Filed 05/23/2007 Page 1 of 6 IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION JACK and RENEE BEAM, Plaintiffs, No. 07 CV 1227 v.
BLACK HILLS SPECIAL SERVICES COOPERATIVE'S POLICY TO PROVIDE EDUCATION CONCERNING FALSE CLAIMS LIABILITY, ANTI-RETALIATION PROTECTIONS FOR REPORTING WRONGDOING AND DETECTING AND PREVENTING FRAUD, WASTE
CASE 0:11-cv-00416-PJS-TNL Document 172 Filed 09/25/13 Page 1 of 7 UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA UNITED STATES OF AMERICA, ex rel. ANDREW ELLIS, HARRIET ELLIS, and MICHAEL W. BLODGETT,
Who is a whistleblower under the False Claims Act? Anyone who sees a Government contractor cheating the United States and wants to do something about it can blow the whistle. If you d like to put a stop
THE USE OF THE FEDERAL FALSE CLAIMS ACT AS A JURISDICTIONAL WEAPON BY CRAFT LABOR UNIONS: CURRENT DEVELOPMENTS Presented to the AGC Labor Lawyers Council by JAMES P. WATSON STANTON, KAY & WATSON, LLP 101
Case: 1:10-cv-00363-WHB Doc #: 31 Filed: 09/02/10 1 of 14. PageID #: 172 IN THE UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO EASTERN DIVISION JAMES MEYER, v. Plaintiff, DEBT RECOVERY SOLUTIONS
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