Introduction
Facts

Decision


Introduction

On 14 March 2018 the Third Circuit affirmed and vacated in part a district court ruling granting the United States' motion for summary judgment. The case raised the following three issues:

  • whether an individual without any ownership interests in a company can face False Claims Act liability for the company's failure to perform a required act to qualify for Medicare reimbursement;
  • whether an unsworn statement is sufficient to create a material issue of fact when weighed against facts admitted during a plea colloquy; and
  • whether a defendant corporation is collaterally estopped from contesting False Claims Act liability or damages based on an individual's plea colloquy.

Facts

In United States ex rel Jane Doe v Heart Solution PC,(1) the United States intervened in a case involving civil False Claims Act claims against a married couple, the Patels, who had previously been convicted of defrauding Medicare. The couple had submitted forged diagnostic reports to Medicare and performed diagnostic neurological testing without the proper level of physician supervision to qualify for Medicare reimbursement. During her plea colloquy, Ms Patel admitted key facts. First, she admitted that she and her husband "own and operate mobile diagnostic companies known as Biosound Medical Services and Heart Solution PC". Second, she admitted that between 2006 and 2014 they had "falsely represent[ed] to Medicare that the neurological testing being performed at Biosound Medical Services was being supervised by a licensed neurologist, when, in fact, it was not".

Decision

The False Claims Act case sought to hold the Patels and their two companies, Biosound and Heart Solution, civilly liable for defrauding Medicare based on the neurological testing fraud. In its motion for summary judgment, the United States argued that Ms Patel's plea colloquy had established all of the required elements of the False Claims Act claim and for that reason summary judgment was appropriate. In their opposition, the defendants relied on Mr Patel's unsworn statement, in which he stated that one of the companies, Biosound, had employed the required level of physician supervision from 2006 to 2007 and 2012 to 2014. The district court granted summary judgment.

Only Ms Patel and Heart Solution appealed. Ms Patel first argued that she could not be liable for any fraud associated with Biosound because she held no ownership interest in the company. However, the Third Circuit rejected this argument, holding that ownership interest is irrelevant to determining False Claims Act liability. The conclusion was based on a straight reading of the elements of a False Claims Act claim: falsity, causation, knowledge and materiality. Ownership is not an element of a False Claims Act claim.

Ms Patel and Heart Solution then argued that the district court had erred in not giving any weight to Mr Patel's unsworn statement. The Third Circuit disagreed, finding that the statement, not being sworn or made under penalty of perjury, was "incompetent summary judgment evidence". Therefore, the court held that the district court had properly ignored Mr Patel's statement.

The Third Circuit then turned to whether Heart Solution was collaterally estopped from contesting liability and damages regarding the alleged False Claims Act violation based on Ms Patel's criminal conviction and plea colloquy. Because Heart Solutions had not been charged with fraud in the Patels' criminal proceeding, the Third Circuit concluded that Heart Solution "did not have any opportunity, much less a 'full and fair opportunity,' to litigate any issue involved in this appeal". Accordingly, the Third Circuit vacated the lower court's ruling as to the collateral estoppel finding.(2)

For further information on this topic please contact Robert J Conlan or Kristen A Knapp at Sidley Austin LLP by telephone (+1 202 736 8000) or email ([email protected] or [email protected]). The Sidley Austin website can be accessed at www.sidley.com.

Endnotes

(1) 17-2019 (3d Cir Mar 14 2019).

(2) A copy of the Third Circuit's opinion is available here.