Justia U.S. D.C. Circuit Court of Appeals Opinion Summaries

In 1973, two Kalamazoo, Michigan hospitals formed a consortium to manage their health education programs and to train interns and residents. In the 1980s, they joined Michigan State University to form the Michigan State University Kalamazoo Center for Medical Studies (KCMS). KCMS administered graduate medical programs for residency programs for the hospitals. The hospitals agreed to incur “joint and equal responsibility for providing [KCMS] with sufficient financing to carry out its programs as negotiated on a yearly basis.” KCMS also received patient-care revenue, support from Michigan State University, and funds from contracts and grants. The hospitals sought reimbursement on their Medicare cost reports (42 U.S.C. 1395ww(h)) during fiscal years 2000–2004 for costs incurred for residents’ training at KCMS’s nonhospital clinics. The Centers for Medicare and Medicaid Services found that the hospitals failed to show they incurred all or substantially all of the costs of their residency programs and that they failed to comply with a requirement of a written agreement detailing the financing of their offsite programs. The district court and D.C. Circuit affirmed the denials of reimbursement, rejecting an argument that the “written agreement” requirement was satisfied by a collection of documents executed over the years. None of the documents met the regulatory criteria. View "Borgess Medical Center v. Burwell" on Justia Law

In this appeal, the United States challenges its liability under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), 42 U.S.C. 9601-75, for a portion of the cost of cleaning up hazardous substances at three California facilities owned by Lockheed. The government acknowledges its own share of CERCLA liability and also that it agreed to reimburse Lockheed’s share via overhead charges on unrelated contracts. At issue is whether the government has a valid claim that the particular mechanism by which the United States will pay its share of the costs of environmental remediation under CERCLA interacts with the parties’ agreed-upon contract-based reimbursement method in a way that impermissibly requires the government to make double payment. The court concluded that the district court’s CERCLA judgment did not create any double recovery and the court rejected the government's arguments to the contrary; the government's protest that the crediting mechanism does not help, but instead harms it further, is unavailing; even assuming the court was in a position to review the equities of the parties’ own choice in their Billing Agreement to resort to the indirect-cost billing and crediting mechanism and their apparent decision to use that mechanism for payment and crediting of future costs, the government has not clearly identified how the crediting mechanism is a source of inequity; and, at this juncture, on appeal from the district court’s judgment imposing no liability on the government for past costs, section 114(b) simply is not implicated. Because the all of the government's claims fail, the court affirmed the judgment. View "Lockheed Martin Corp. v. United States" on Justia Law

Relator filed a qui tam action against Phillip Morris, alleging that the company violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by charging NEXCOM and AAFES prices for cigarettes that violate the terms of their contracts. The district court concluded that it lacked jurisdiction to hear the claim under the FCA's public disclosure bar. The court concluded that the transactions that relator contends create an inference of fraud were publicly disclosed through a statutorily enumerated channel, triggering the jurisdictional bar. The court further concluded that relator does not possess any direct information about the underlying transactions that would allow him to rescue his claim from the jurisdictional bar by qualifying as an original source. Accordingly, the court affirmed the judgment. View "United States v. Philip Morris USA Inc." on Justia Law

This appeal concerns CityCenterDC, a large private development in the heart of Washington, D.C. At issue is whether the Davis-Bacon Act, 40 U.S.C. 3142(a), applies to the construction of CityCenterDC. In this case, the court concluded that the District of Columbia was not a party to the construction contracts for the building of CityCenterDC, and CityCenterDC is not a “public work.” Based on either of these two alternative and independent reasons, the court determined that the Davis-Bacon Act does not apply to the construction of CityCenterDC. Accordingly, the court affirmed the judgment of the district court. View "District of Columbia v. DOL" on Justia Law

Relator filed a qui tam action under the False Claims Act, 31 U.S.C. 3729-3733, contending that Record Press had submitted a fraudulent bill for printing services to the government. The district court granted judgment for Record Press. The court affirmed the district court's conclusion because there was no evidence that Record Press had submitted any false claims with knowledge it was doing so, as would be required for liability under the Act. In this case, the district court properly considered testimony and evidence indicating that the government agreed with Record Press about the disputed contract rate. Further, the district court did not consider the government’s understanding of the contract as part of any defense. Rather, it relied on the government’s agreement with Record Press about the proper understanding of the contract as evidence that there had been no fraudulent behavior in the first place. The court remanded for further proceedings on Record Press’s motion for attorneys’ fees because the district court did not make the findings necessary to enable the court to review its grounds for denying a fee award. View "United States v. Record Press, Inc." on Justia Law

After the United States prevailed in a civil action brought pursuant to the False Claims Act (FCA), 31 U.S.C. 3729, based on certifications by MWI to the Bank to secure loans financing MWI's sale of water pumps to Nigeria, a jury awarded the government $7.5 million in damages. The damages were trebled to $22.5 million pursuant to the FCA. Because an FCA defendant is entitled to an offset from the trebled damages by any amount paid to compensate the government for the harm caused by the false claims, and the district court considered Nigeria’s repayment of the loan to be compensatory, MWI’s damages were reduced from $22.5 million to $0. The district court did impose civil penalties at the highest level. The government appealed and MWI cross-appealed. The court reversed the judgment because the government failed to establish that MWI knowingly made a false claim. Absent evidence that the Bank, or other government entity, had officially warned MWI away from its otherwise facially reasonable interpretation of an undefined and ambiguous term, the FCA’s objective knowledge standard, as the Supreme Court clarified while this litigation was pending in Safeco Insurance Co. of America v. Burr, did not permit a jury to find that MWI “knowingly” made a false claim. View "United States ex rel. Purcell v. MWI Corp." on Justia Law

Upon remand of relator's qui tam suit, the district court ruled that the District violated the False Claims Act (FCA), 31 U.S.C. 3729(a), when it submitted a Medicaid reimbursement claim for FY 1998 and imposed the maximum penalty of $11,000. Both parties appealed. The court reversed and remanded, concluding that the relevant federal regulations, which were incorporated into the District’s Medicaid State Plan, required the District to maintain records supporting its Medicaid reimbursement claims that could be produced for audit. Pursuant to contractual obligations, relator’s firm was to prepare the FY 1998 interim Medicaid claims and year-end cost report, and consequently his firm, not the District, had physical possession of the underlying documentation supporting the District’s claim. Given this arrangement, the District reasonably understood when it submitted the claim for payment that it could, through the firm, make the supporting records available for audit. View "United States ex. rel. Davis v. District of Columbia" on Justia Law

Relator filed a qui tam suit against AT&T and nineteen of its subsidiaries. At issue is whether an earlier and still pending qui tam lawsuit filed against a single AT&T subsidiary bars this suit under the False Claims Act’s first-to-file rule, 31 U.S.C. § 3730(b)(5), which prohibits qui tam actions that rely on the same material fraudulent actions alleged in another pending lawsuit. The court held that the first-to-file bar does not apply because the Wisconsin action alleges fraud based on affirmative pricing misrepresentations by seemingly rogue Wisconsin Bell employees. The present complaint, by contrast, alleges fraud and its concealment arising from a centralized and nationwide corporate policy of failing to enforce known statutory pricing requirements. In the alternative, the complaint does not fail to plead the alleged fraud with sufficient particularity under Federal Rule of Civil Procedure 9(b) where the complaint lays out in detail the nature of the fraudulent scheme, the specific governmental program at issue, the specific forms on which misrepresentations were submitted or implicitly conveyed, the particular falsity in the submission’s content, its materiality, the means by which the company concealed the fraud, and the timeframe in which the false submissions occurred. Accordingly, the court reversed the district court's judgment and remanded for further proceedings. View "USA ex rel. Todd Heath v. AT&T, Inc." on Justia Law

The Medicare program provides federally funded healthcare to the elderly and the disabled. See Title XVIII of the Social Security Act, 42 U.S.C. 1395. Under a “complex statutory and regulatory regime” called Medicare Part A, the Government reimburses participating hospitals for care that they provide to inpatient Medicare beneficiaries. Most hospitals are reimbursed for inpatient hospital services pursuant to a standardized rate, but the Social Security Act also provides a method for calculating reimbursement rates for certain rural hospitals that qualify as “sole community hospital[s]” (SCHs) or that qualify as “medicare-dependent small rural hospital[s]” (MDHs). SCHs and MDHs receive reimbursement based on either the standard rate or a hospital-specific rate derived from its actual costs of treatment in one of the base years specified in the statute, whichever is higher. MDHs and SCHs challenged revisions to the rules covering their Medicare reimbursements for inpatient hospital services, arguing that the Medicare statute forbids the Secretary from modifying the hospitals’ reimbursements with budget neutrality adjustments from years prior to the base year. The district court rejected the claims. The D.C. Circuit affirmed, finding that the revisions were neither arbitrary nor manifestly contrary to the statute. View "Adirondack Med. Ctr. v. Burwell" on Justia Law

The Tribe filed claims in 2005 against the Department for unpaid contract support costs that accrued from 1996 through 1998. At issue was whether the Tribe may sue under the doctrine of equitable tolling even though the statute of limitations has lapsed. The court concluded that the Tribe's claims were barred by the statute of limitations because the legal misunderstandings and tactical mistakes the Tribe identified did not amount to extraordinary circumstances justifying equitable tolling. Accordingly, the court affirmed the judgment of the district court. View "Menominee Indian Tribe v. United States" on Justia Law