567 F. App'x 44
2d Cir.2014Background
- Relator alleges Huron submitted Medicare claims for outlier payments not entitled to, violating FCA and NY FCA.
- Empire, as fiscal intermediary, allegedly failed to properly review those claims before payment.
- District court granted summary judgment for defendants, finding no prohibited statute/regulation and proper compliance by Empire.
- Relator appeals; Empire and Huron cross-appeal arguing lack of subject matter jurisdiction due to public disclosures and not original source.
- Court affirms district court’s judgment, ruling jurisdiction exists and there is no genuine dispute on prohibited practices.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Jurisdiction under FCA §3730(e)(4)? | Relator contends original source requirement not satisfied. | Defendants argue lack of jurisdiction due to public disclosures. | Jurisdiction exists under §3730(e)(4). |
| Whether summary judgment on FCA/NY FCA claims was proper? | Relator asserts prohibited conduct in claim submission. | Huron/Empire contend no statute/regulation prohibits practices and evidence insufficient. | Summary judgment affirmed; no evidence of prohibited conduct shown. |
| Whether record shows any statute/regulation prohibiting increased charges unrelated to costs? | Relator asserts regulations prohibit such increases. | Defendants maintain no prohibitory statute/regulation; Empire complied. | No material evidence showing such prohibition; district court correct. |
Key Cases Cited
- United States ex rel. Kirk v. Schindler Elevator Corp., 601 F.3d 94 (2d Cir. 2010) (subject-matter jurisdiction under FCA public-disclosure bar; later overruled on other grounds)
- Gonzalez v. City of Schenectady, 728 F.3d 149 (2d Cir. 2013) (de novo review standard for summary judgment)
- Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (Supreme Court 1986) (summary judgment standard; rational trier of fact requirement)
- Terry v. Ashcroft, 336 F.3d 128 (2d Cir. 2003) (ambiguous facts resolved in favor of non-movant in summary judgment)