UNITED STATES of America ex rel. Marc OSHEROFF, Plaintiff-Appellant, v. HUMANA, INC., et al., Defendants-Appellees.
No. 13-15278
United States Court of Appeals, Eleventh Circuit
Jan. 16, 2015
776 F.3d 805
David Jeffrey Leviss, K. Lee Blalack, II, Sara Zdeb, Amanda M. Santella, O‘Melveny & Myers, LLP, Washington, DC, Andrew Russell Kruppa, Daniel Christopher Mazanee, Squire Patton Boggs (U.S.) LLP, John Clifford Hanson, II, The Barthet Firm, Miami, FL, for Defendants-Appellees.
Before TJOFLAT, JILL PRYOR and FAY, Circuit Judges.
JILL PRYOR, Circuit Judge:
This appeal follows the district court‘s dismissal of a qui tam complaint upon holding that the lawsuit was barred by the public disclosure provision of the False Claims Act. After careful review of the record and the briefs, and with the benefit of oral argument, we affirm.
I.
Relator Marc Osheroff operates medical office buildings in Miami and has considered opening a health clinic there since the early 2000s. While doing market research on health clinics, Mr. Osheroff learned that many area clinics provide a variety of free services to patients. Upon learning of these programs, Mr. Osheroff began to research the clinics’ services in more detail by interviewing employees and patients. Mr. Osheroff has never been employed by or done business with any of the defendants.
Mr. Osheroff filed this qui tam action under seal on December 16, 2010, and the United States declined to intervene. Mr. Osheroff amended his complaint in December 2011, reducing the named defendants
The amended complaint includes information Mr. Osheroff gathered through his interviews, as well as information from the clinics’ websites. Specifically, Mr. Osheroff alleges that the clinics provided, and the Humana defendants either knew of or promoted, a variety of free services for patients and health plan members, including transportation, meals, spa and salon services, and entertainment. The amended complaint includes a great amount of detail about these services. For example, the amended complaint alleges that: the clinics used limo-class vehicles to transport patients and “nearly all trips ... contained two or fewer passengers even though the vehicles seat 8, 10 or more” passengers, Am. Compl. at 21, ¶ 130; CAC limos took 93 trips to Mr. Osheroff‘s medical office buildings in early 2010, 88 of which carried two or fewer people, id.; lunch at a CAC clinic on October 7, 2010 included “white rice, meat, [and] plantains, but the options change daily,” id. at 29, ¶ 201; lunch at a Pasteur clinic on June 17, 2010 included “rice and beans, meat, bread, soft drink, and vegetables,” id. at 31, ¶ 219; the clinics provided takeaway containers for lunch, id. at 29, ¶ 203; and the clinics held holiday and birthday parties with meals, soda, and cake. Id. at 32, ¶ 221.
Mr. Osheroff alleges that the clinics offered these services without regard for medical purpose or financial need and that the value of the services is more than nominal. To show the worth of the clinics’ services, the amended complaint includes the price of comparable services, including the taxi and limo rates in Miami-Dade County, id. at 23, ¶¶ 138-42, and the price of a Cuban sandwich and a hot lunch special at a local restaurant. Id. at 37, ¶¶ 247-48.
The Anti-Kickback Statute (“AKS“),
The defendant clinics and the Humana defendants moved to dismiss the amended
II.
We review a district court‘s decision on a motion to dismiss de novo. Martes v. Chief Exec. Officer of S. Broward Hosp. Dist., 683 F.3d 1323, 1325 (11th Cir.2012). We also review questions of statutory interpretation and retroactivity de novo. Gonzalez v. McNary, 980 F.2d 1418, 1419 (11th Cir.1993); Goldsmith v. City of Atmore, 996 F.2d 1155, 1159 (11th Cir.1993). We review a district court‘s denial of an evidentiary hearing for an abuse of discretion. United States v. Brown, 441 F.3d 1330, 1350 (11th Cir.2006).
III.
The FCA prohibits fraud against government programs. Section 3730 of the act allows either the United States government or private citizens to file civil lawsuits to enforce the FCA, but it bars private qui tam suits based on publicly disclosed information. In 2010, Congress amended the FCA‘s public disclosure bar as part of the Patient Protection and Affordable Care Act (“PPACA“), Pub.L. No. 111-148, 124 Stat. 119 (2010). This case raises issues related to the impact of the amendments and the current application of the public disclosure bar. In this appeal, we must decide four questions: (1) whether the 2010 amendments to
A.
The district court held that the 2010 amendments to the public disclosure provision do not apply retroactively, citing Graham County Soil & Water Conservation District v. United States ex rel. Wilson, 559 U.S. 280, 283 n. 1, 130 S.Ct. 1396, 176 L.Ed.2d 225 (2010). The court applied the prior version of
Mr. Osheroff argues that the amended statute should apply to all conduct alleged in the amended complaint, regardless of when it occurred. But he waived this argument because he failed to raise it in the district court. See Sterling Fin. Inv. Grp., Inc. v. Hammer, 393 F.3d 1223, 1226 (11th Cir.2004). In fact, his argument in the district court assumed the opposite. While he contended that certain state court filings should not be considered because the amended
B.
Next, we must decide whether the amended statute is jurisdictional or presents grounds for dismissal for failure to
The prior version of
We conclude that the amended
Accordingly, we will treat defendants’ motions to dismiss as motions made under Federal Rule of Civil Procedure 12(b)(6) as to the claims based on alleged conduct that occurred on or after March 23, 2010.
C.
Mr. Osheroff next makes two separate but related arguments: (1) the district court should not have considered documents extrinsic to the complaint because Rule 12(b)(6) standards apply, and (2) even if Rule 12(b)(1) applies, the district court should not have ruled on the defendants’ factual challenge without first allowing discovery and/or holding an evidentiary hearing. Mr. Osheroff has forfeited his second argument, however, because he failed to request an evidentiary hearing or further discovery in the district court. See United Techs. Corp. v. Mazer, 556 F.3d 1260, 1280-81 (11th Cir.2009).
As regards Mr. Osheroff‘s first argument, all of the evidence at issue here was properly before the district court, regardless of which Rule 12 standard applies. For purposes of Rule 12(b)(1) review for a factual attack on jurisdiction, which applies to conduct alleged to have occurred on or prior to March 23, 2010, the district court was permitted to consider extrinsic documents, including all of the documents in the record here. See Morrison v. Amway Corp., 323 F.3d 920, 924 n. 5 (11th Cir.2003). For purposes of Rule 12(b)(6) review, which applies to conduct alleged to have occurred on or after March 23, 2010, a court generally may not look beyond the pleadings. See Garcia v. Copenhaver, Bell & Assocs., M.D.‘s, P.A., 104 F.3d 1256, 1266 n. 11 (11th Cir.1997). The pleadings include any information attached to a complaint.
Here, the district court considered documents that were attached to Mr. Osheroff‘s amended complaint and were part of the pleadings. The court also took judicial notice of the complete list of documents in the defendants’ unopposed motion for judicial notice, including five Miami Herald articles, two advertisements in the Miami Herald, the transcript of a hearing in another case involving a defendant clinic in state court, and the Special Master‘s Report in that case.4 None of
D.
Having disposed of the preliminary issues, we now consider whether the FCA‘s public disclosure provision bars this lawsuit. The prior version of
In Cooper v. Blue Cross Blue Shield of Florida, Inc., 19 F.3d 562, 565 n. 4 (11th Cir.1994), this Court articulated a three-part test for deciding if the public disclosure bar in the prior version of the statute applies: “(1) have the allegations made by the plaintiff been publicly disclosed; (2) if so, is the disclosed information the basis of the plaintiff‘s suit; and (3) if yes, is the plaintiff an ‘original source’ of that information.”
The amended public disclosure provision prohibits lawsuits where the allegations in the complaint are “substantially the same” as (rather than “based upon“) allegations or transactions contained in public disclosures, unless the plaintiff is an original source.
1.
Under the Cooper test, we first ask whether the allegations or transactions at issue were publicly disclosed. To answer this question, we must consider whether the sources on which the defendants rely fall into the statute‘s enumerated categories of sources that are considered public. This appeal concerns two of those categories: court filings and news media.
The defendants rely in part on disclosures made in Florida state court in the case of Pasteur Med. Center, Inc. v. Wellcare of Florida, Inc., 943 So.2d 144 (Fla. Dist.Ct.App.2006) (“the Wellcare litigation“). Before the 2010 amendments to the FCA, information disclosed in both federal and state court proceedings was considered publicly disclosed. Graham Cnty., 559 U.S. at 283, 130 S.Ct. 1396. After the 2010 amendments, only information disclosed in federal court proceedings may be considered public disclosures.
Documents from the Wellcare litigation disclose information about Pasteur‘s practices, including providing food and haircuts.5 The Special Master‘s Report in the case also discussed at length Pasteur‘s provision of free coffee and pastries, various holiday parties featuring free food and entertainment, free breakfast and lunch, and free transportation. The special master concluded that Pasteur‘s practices could violate the AKS in the aggregate and recommended that Pasteur “be required to create a costs tracking methodology to en-
Next, the defendants rely on disclosures that they contend qualify as “news media,” and thus are public disclosures under the statute, including articles in the Miami Herald, newspaper advertisements, and the clinics’ own websites. Newspaper articles clearly qualify as news media. See Graham Cnty., 559 U.S. at 300, 130 S.Ct. 1396. The Miami Herald articles describe various clinic services. For example, the article “Upbeat Checkups” disclosed in March 2007 that the defendants provided “free exercise classes,” “free lunch,” daily social events, “free coffee and breakfast pastries,” and free transportation to and from the clinics.6 John Dorschner, Upbeat Checkups, MIAMI HERALD, Mar 12, 2007 at 22. The article noted that “patients get Ritz-Carlton treatment” and “everything is paid for by taxpayer dollars.” Id. Another Miami Herald article from 2001 described a CAC clinic as providing a “wealth of services, including transportation to and from the clinics.” Shannon Tan, Diagnosis is Confusion as Patients Flood Clinics, MIAMI HERALD, Dec. 8, 2001, at 1C.
This Court has not yet determined whether the scope of “news media” as used in
Because the term “news media” has a broad sweep, we conclude that the newspaper advertisements and the clinics’ publicly available websites, which are intended to disseminate information about the clinics’ programs, qualify as news media for purposes of the public disclosure provision. Like the Miami Herald articles, these sources also discuss the clinics’ free services and programs. An advertisement in the Miami Herald stated that one of the Humana defendants, CarePlus, provided health plans with benefits including “$0 for unlimited transportation.” CarePlus Advertisement, MIAMI HERALD, Oct. 26, 2010, at 20A. In addition, CAC‘s website, in the version attached to the amended complaint, disclosed “free transportation services and a variety of educational programs and group activities,” Am. Compl. Ex. 1 at 3; “[c]omplimentary lunch ... on a daily basis,” id.; and “massage, [and] monthly birthday parties.” Id. at 4. Pasteur‘s website, in the version attached to
Based on the sources in question here, the first prong of the Cooper test is met. The allegations or transactions on which the defendants rely in support of their motions to dismiss have been publicly disclosed.
2.
The second part of the Cooper test asks whether the disclosed information forms the basis of the plaintiff‘s lawsuit. “[A] plaintiff basing an FCA qui tam claim in any part on ... publicly disclosed information must demonstrate that the plaintiff is an original source of that information.” Battle v. Bd. of Regents, 468 F.3d 755, 762 (11th Cir.2006) (emphasis added). Under the amended statute, we must also analyze whether the complaint‘s allegations are “substantially the same” as the publicly disclosed allegations or transactions.
Mr. Osheroff argues that his amended complaint is not “based on” or “substantially the same” as the public disclosures because the disclosures do not contain any allegations of wrongdoing. He relies on language in Cooper, where we stated that a source was not a public disclosure because it did “not allege that [defendant] in its capacity as a primary insurer actually engaged in wrongdoing.” Id. at 567. We agree with the district court that Mr. Osheroff reads Cooper too narrowly. In Cooper, we rejected the disclosure in question because it discussed the defendant “only in the context of its role as an intermediary responsible for monitoring payment to hospitals” and not “in its capacity as a primary insurer,” which was the focus of the complaint. Id. Cooper does not require each source to contain an allegation of wrongdoing. Indeed,
The amended complaint plainly is based, at least “in ... part,” on the publicly disclosed information discussed above. Battle, 468 F.3d at 762. The allegations in the complaint are also substantially similar to the publicly disclosed information. Mr. Osheroff‘s essential allegation is that the clinics provided a wealth of free services. The public sources fully disclose that the defendant clinics provided such services, including transportation, meals, entertainment, and spa services, at no cost. Because the second prong is a “quick trigger,” Cooper, 19 F.3d at 568 n. 10, the significant overlap between Mr. Osheroff‘s allegations and the public disclosures is sufficient to show that the disclosed information forms the basis of this lawsuit and is substantially similar to the allegations in the complaint.
3.
Our final inquiry under Cooper is whether Mr. Osheroff is an original source of the information in the amended complaint. Under the prior version of
Under the amended statute, an original source is someone who has “knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions.”
Mr. Osheroff argues that he is an original source because he conducted his own investigation of the programs offered at the clinics. The amended complaint includes some details that are not present in the public disclosures, such as the type of food the clinics served for lunch, the destinations of some of the free transportation, the frequency of salon services, and the price of substitute services or goods. Mr. Osheroff claims that this information is direct and independent because of his investigation and that it materially adds to the public disclosures because it shows that the clinics’ services were more than nominal in value.7
We are not persuaded. Under the AKS, any remuneration or offer of remuneration is illegal.
Similarly, under the amended statute, we conclude that Mr. Osheroff‘s information does not materially add to the public disclosures, which were already sufficient to give rise to an inference that the clinics were providing illegal remuneration to patients. See United States ex rel. Kraxberger v. Kan. City Power & Light Co., 756 F.3d 1075, 1079 (8th Cir.2014) (holding that a plaintiff‘s information did not materially add to the public disclosures because the disclosures already revealed “‘the essential elements comprising that fraudulent transaction ... so as to raise a reasonable inference of fraud.‘“) (quoting United States ex rel. Rabushka v. Crane Co., 40 F.3d 1509, 1514 (8th Cir.1994)). Our holding also comports with the purpose of the original source doctrine, which is to “increase private citizen involvement
IV.
Under the prior or amended version of
AFFIRMED.
