United States Ex Rel. Osheroff v. Humana, Inc.
2015 U.S. App. LEXIS 716
| 11th Cir. | 2015Background
- Osheroff filed a sealed qui tam in 2010 alleging clinics Pasteur, CAC, and MCCI and Humana defendants engaged in free services to patients funded by taxpayer dollars.
- Amended complaint added detailed claims about free transportation, meals, entertainment, spa services, and parties at the clinics.
- Allegations relied on AKS and CMPL violations and implied false certification under the FCA.
- District court dismissed the action as barred by the FCA public disclosure provision; government did not intervene.
- PPACA amended the FCA’s public disclosure bar in 2010; issues include retroactivity, jurisdictional nature, and use of extrinsic documents.
- Court addresses applicability of amendments, governance of public disclosures, and whether the action is barred.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Retroactivity of 2010 amendments | Osheroff argues amendments apply to all conduct in the complaint. | District court held amendments do not apply retroactively. | Waived retroactivity argument; amendments apply prospectively. |
| Jurisdiction vs dismissal grounds | Public disclosure bar is jurisdictional under old interpretation. | Amendments create dismissal grounds, not jurisdiction. | Amended § 3730(e)(4) is a ground for dismissal, not a jurisdictional bar. |
| Use of extrinsic documents at Rule 12(b)(6) | Extrinsic materials should not be used under Rule 12(b)(6). | Extrinsic documents central and authentic may be considered. | Extrinsic materials properly considered; substantial to the complaint. |
| Public disclosure bar applicability | Disclosures do not reveal wrongdoing; not substantially the same. | Disclosures (court filings, news media, websites) are public and substantially similar to the complaint. | Public disclosure bar applies; complaint dismissed. |
Key Cases Cited
- Graham County Soil & Water Conservation Dist. v. United States ex rel. Wilson, 559 U.S. 280 (Supreme Court 2010) (public disclosure retroactivity and scope of news media)
- Cooper v. Blue Cross Blue Shield of Florida, Inc., 19 F.3d 562 (11th Cir. 1994) (three-part Cooper test for public disclosure bar)
- Rockwell Int’l Corp. v. United States, 549 U.S. 457 (Supreme Court 2007) (jurisdictional analysis under FCA pre- and post-amendments)
- McCoy v. United States, 266 F.3d 1245 (11th Cir. 2001) (original source doctrine background knowledge limits)
- United States ex rel. Kraxberger v. Kan. City Power & Light Co., 756 F.3d 1075 (8th Cir. 2014) (original source material additions not sufficient)