United States Ex Rel. Goldberg v. Rush University Medical Center
2012 U.S. App. LEXIS 10138
| 7th Cir. | 2012Background
- Medicare pays teaching hospitals for resident-performed services on a fee-for-service basis only when a supervising teaching physician is present.
- Costs of resident education are reimbursed via grants, not per-service payments.
- In the 1990s HHS audits and GAO PATH reports suggested industry-wide billing for unsupervised resident work, prompting reimbursements demand.
- Qui tam relators sued Rush University, alleging supervised—but inadequately supervised—resident work was billed as unsupervised.
- District court dismissed the suit as barred by public-disclosure provisions; relators appealed, arguing narrower, non-disclosive allegations.
- Seventh Circuit remanded, clarifying that public disclosures must be interpreted narrowly and that the complaint’s specifics may be non-disclosive.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the suit barred as based on a public disclosure? | Goldberg/Beecham contend disclosures are not broad, and their specifics differ from PATH/GAO. | Rush argues allegations are substantially based on public PATH/GAO disclosures and barred. | Not barred; disclosures must be interpreted narrowly; case remanded for merits. |
| Does Baltazar require a high level of generality to bar private suits? | Baltazar permits non-generic, specific misrepresentation claims not foreclosed by public reports. | Baltazar supports dismissal where disclosures cover broad practices, not specific hospital frauds. | Baltazar requires non-general disclosure; allegations here are not substantially similar to public disclosures. |
| Are the claims about immediate availability of teaching physicians a non-disclosive theory? | Theory targets a novel deceit not described by GAO PATH audits. | Path audits encompassed unsupervised billing broadly; the theory repeats public disclosures. | On remand, merits determine if allegations are substantially similar or genuinely new. |
Key Cases Cited
- Baltazar v. Warden, 635 F.3d 866 (7th Cir. 2011) (high level of generality barred; need particularized disclosure)
- United States ex rel. Gear v. Emergency Medical Associates of Illinois, Inc., 436 F.3d 726 (7th Cir. 2006) (public disclosure must not reveal the specific fraud in a way that blocks private suits)
- Glaser v. Wound Care Consultants, Inc., 570 F.3d 907 (7th Cir. 2009) (private suits based on substantially similar disclosures require more specificity)