Justia U.S. 3rd Circuit Court of Appeals Opinion Summaries

Under the South Pacific Tuna Treaty (SPTT), a limited number of licenses to fish the waters of the Pacific Island nations are available to vessels under the control and command of U.S. citizens. Moore, a law firm, filed suit under the False Claims Act against Korean nationals and LLCs, alleging that the LLCs acquired two SPTT licenses by fraudulently certifying to the U.S. government that they were controlled by U.S. citizens and that their fishing vessels were commanded by U.S. captains. Moore first learned of this alleged fraud through discovery in a wrongful death action that it litigated in federal court against two of the defendants. The district court dismissed, citing the FCA’s public disclosure bar and its “original source” exception, particularly the 2010 amendments to those provisions. The Third Circuit reversed, finding that the alleged fraud was disclosed through any of the qualifying public disclosure sources, but that Moore has materially added to those public disclosures by contributing details of the alleged fraud that it independently uncovered through discovery in the wrongful death action in federal court. The court noted that the public disclosure bar is no longer jurisdictional. View "Moore & Co., P A v. Majestic Blue Fisheries LLC" on Justia Law

In 2000 the Port Authority signed a 30-year lease for the largest marine terminal at Port Elizabeth (445 acres including structures and berthing) with Maher, which handles cargo. The Lease requires “Basic Rental,” (in 2012, $50,413 per acre, totaling $22,433,612) plus “Container Throughput Rental,” based on the type and volume of cargo at Maher’s terminal. For eight years, Maher was exempted from Throughput Rental. Since 2008 the first 356,000 containers are exempted; for containers 356,001 to 980,000, Maher paid $19.00 per container in 2012; and for each additional container, Maher paid $14.25. Maher must handle a minimum amount of cargo to maintain the Lease and pay an annual guaranteed minimum Throughput Rental. Maher paid $12.5 million in Throughput Rental in 2010, and expected the 2012 amount to be $14 million. Maher claims the Port Authority profits from the Lease and uses the revenue to fund harbor improvements and projects unrelated to services provided to Maher or vessels. In 2012 Maher sued, alleging violations of the Constitution’s Tonnage Clause; the Rivers and Harbors Appropriation Act, 33 U.S.C. 5(b); and the Water Resources Development Act, 33 U.S.C. 2236. The Third Circuit affirmed dismissal, agreeing that Maher lacked standing to bring its Tonnage Clause and RHA claims because it was not a protected vessel and did not adequately plead that fees imposed on vessels were not for services rendered. Maher’s WRDA claim failed because Maher had not shown that the Authority imposed fees on vessels or cargo and because the WRDA did not prohibit use of Lease revenue to finance harbor improvements. View "Maher Terminals LLC v. Port Auth. of NY" on Justia Law

Nagle and Fink were co-owners and executives of concrete manufacturing and construction businesses. The businesses entered into a relationship with a company owned by a person of Filipino descent. His company would bid for subcontracts on Pennsylvania transportation projects as a disadvantaged business enterprise. Federal regulations require states that receive federal transportation funds to set annual goals for participation in transportation construction projects by disadvantaged business enterprises, 49 C.F.R. 26.21. If his company won the bid for the subcontract, Nagle and Fink’s businesses would perform all of the work. Fink pled guilty to conspiracy to defraud the United States. A jury found Nagle guilty of multiple charges relating to the scheme. The Third Circuit affirmed Nagle’s conviction, upholding the admission of electronic evidence discovered during searches of the businesses’ offices, but vacated both sentences, based on loss calculation errors. View "United States v. Nagle" on Justia Law

Hospitals that are disadvantaged by their geographic location may reclassify to a different wage index area for certain Medicare reimbursement purposes by applying for redesignation to the Medicare Geographic Classification Review Board. Section 401 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, enacted 10 years after the Board was established, creates a separate mechanism by which qualifying hospitals located in urban areas “shall [be] treat[ed] . . . [as] rural” for the same reimbursement purposes. To avoid possible strategic maneuvering by hospitals, the U.S. Department of Health and Human Services issued a regulation providing that hospitals with Section 401 status cannot receive additional reclassification by the Board on the basis of that status, 42 C.F.R. 412.230(a)(5)(iii) (Reclassification Rule). Geisinger, a hospital located in an urban area, received rural designation under Section 401 but was unable to obtain further reclassification by the Board pursuant to the Reclassification Rule. Geisinger sued. The district court upheld the regulation. The Third Circuit reversed, finding that Section 401 is unambiguous: HHS shall treat Section 401 hospitals as rural for Board reclassification purposes, 42 U.S.C. 1395ww(d)(8)(E)(i) View "Geisinger Cmty. Med. Ctr. v. Sec'y United States Dep't of Health & Human Servs." on Justia Law

Dougherty, the Business Officer for Operations for the Philadelphia School District, was accountable for the Office of Capital Programs (OCP), which developed projects for School Reform Commission (SRC) approval. Dougherty reported to Nunery, who reported to Superintendent Ackerman. Ackerman directed OCP to install security cameras in “persistently dangerous” schools. Due to a short time frame, OCP could not use its bidding process and was required to select a pre-qualified contractor. Dougherty identified SDT as such a contractor, prepared a proposal, and submitted a resolution to Nunery. Under District policy, the Superintendent must approve the resolution before it is presented to the SRC. Dougherty did not receive a response from Nunery or Ackerman, nor was the resolution presented to the SRC. Ackerman allegedly rejected the SDT proposal for lack of minority participation, and directed that IBS, a minority-owned firm, be awarded the contract. IBS was not pre-qualified. SRC ratified the plan. Conflicts arose. Dougherty met with reporters, resulting in articles accusing Ackerman of violating state guidelines, and contacted the FBI, state representatives, and the U.S. Department of Education. Ackerman placed Dougherty on leave pending an investigation, which concluded that there was no unlawful motive in the contract award, but that Dougherty violated the Code of Ethics confidentiality section. SRC terminated Dougherty. In his suit, alleging First Amendment retaliation and violations of the Pennsylvania Whistleblower Law, the district court denied motions for summary judgment on the basis of qualified immunity. The Third Circuit affirmed. View "Dougherty v. Philadelphia Sch.Dist." on Justia Law

Schumann, as a qui tam relator under the False Claims Act (FCA), 31 U.S.C. 3729, and corresponding state laws, alleged that the drug company defendants improperly induced Medco Health, his employer, to offer certain of defendants’ drugs in its mail-order pharmacies and in health plans it managed; did not include those inducements when calculating the best price for their drugs, and thus submitted inaccurate best price reports to the government; overcharged the government based on those inaccurate best prices; and underpaid rebates owed based on those inaccurate best prices. The district court dismissed, holding that it lacked subject matter jurisdiction over Schumann’s claims because he did not have the requisite direct and independent knowledge to satisfy the original source exception to the FCA’s public disclosure bar. The Third Circuit affirmed. Schumann’s knowledge was not direct because it came from reviewing documents and discussing them with colleagues who participated in the underlying events. View "Schumann v. Astrazeneca Pharm., L.P." on Justia Law

Foglia, an RN, was hired by Renal, a dialysis care services company, in 2007, and was terminated in 2008. Foglia filed a qui tam complaint against Renal under the False Claims Act, 31 U.S.C. 3729, in 2009. The United States chose not to intervene. In a second amended complaint, Foglia claimed that Renal falsely certified that it was in compliance with state regulations regarding quality of care, falsely submitted claims for reimbursement for the drug Zemplar, and re-used single-use Zemplar vials. The court dismissed, finding that Foglia had failed to state his claim with the heightened level of particularity required by Federal Rule of Civil Procedure 9(b) for fraud claims. The court noted Foglia’s failure to provide a “representative sample” or to “identify representative examples of specific false claims” and that even if Foglia’s claim had met the requirement of Rule 9(b), Foglia “provided no authority under an express or implied false certification theory that the claims submitted … violated a rule or statute establishing compliance as a condition of payment.” Foglia appealed dismissal of his claim of over-billing on Zemplar. The Third Circuit reversed, noting that it was a close case, the need to assume that Foglia was correct in alleging that Renal did not follow proper procedures if it was to harvest “extra” Zemplar from used vials, and that only Renal has access to the documents that could prove the claim.View "Foglia v. Renal Ventures Mgmt., LLC" on Justia Law

Medicare (42 U.S.C. 1395ww) reimbursement includes an adjustment for “disproportionate share hospitals” (DSH), that serve high numbers of low-income patients. The calculation formula takes into account the number of patient days for those patients eligible for Medicaid, and may also include patient days for those patients ineligible for Medicaid, but who received benefits under a Medicaid “demonstration project,” 42 U.S.C. 1315. The Medicare DSH formula was initially regarded by intermediaries, at least in some states, as including days covered under state general assistance (GA) and charity care programs. In 1999 the Centers for Medicare and Medicaid Services clarified that the DSH formula only permitted the inclusion of patient days wherein the patients were eligible for Medicaid, excluding state general assistance and charity plan patient days, but, under the final rule hospitals could count patient days for individuals covered under a Section 1115 waiver project. The Deficit Reduction Act of 2005 essentially ratified the rule. The district court concluded that the regulation was arbitrary and capricious and a violation of the Equal Protection Clause, reasoning there was no rational basis to exclude from reimbursements patients covered by Pennsylvania’s General Assistance plan, while including patients covered under a federal statutory waiver program. The Third Circuit reversed. View "Nazareth Hosp. v. Sec'y, U.S. Dep't of Health & Human Servs." on Justia Law

Zizic is the former CEO of BioniCare, which sold the BIO-1000, a medical device designed to treat osteoarthritis of the knee. BioniCare attempted to bill Medicare for the BIO-1000, but many claims were denied as not medically necessary. Q2A contracted with the government to review such claim denials across the nation. Q2A’s denials were reached without physician review, which is required by the Medicare Act, 42 U.S.C. 1395, HHS regulations, and its contract. A former Q2A employee testified that it implemented an internal policy to deny all BIO-1000 claims, which were reviewed by a single nurse rather than a panel of physicians; later allowed non-physician subcontractors to prepare BIO-1000 appeals for review by a single physician; and finally developed a mail merge letter that automatically denied BIO-1000 claims without any review. BioniCare’s trustee in bankruptcy became aware of and disclosed these practices. Zizic filed a qui tam suit under the False Claims Act, 31 U.S.C. 3729-33. The district court dismissed, concluding that it lacked jurisdiction because the allegations against Q2A and RTS were based on prior public disclosures and because Zizic was not an original source of that information. The Third Circuit affirmed. View "Zizic v. Q2Adm'rs LLC" on Justia Law

During the Iraq War, the U.S. military established the Radwaniyah Palace Complex as a base of operations. Staff Sergeant Maseth was stationed there and assigned to live in a barracks building that predated the war and was known to have significant electrical problems. In 2008, Staff Sergeant Maseth died by electrocution while taking a shower in the barracks. The shower was electrified by an ungrounded, unbonded water pump. Maseth’s estate and his parents sued KBR, a military contractor hired to perform maintenance services at the barracks. The district court dismissed, holding that the case was nonjusticiable and, alternatively, that the claims were preempted by the federal policy embodied in the Federal Tort Claims Act’s combatant activities exception, 28 U.S.C. 2680(j). The Third Circuit reversed and remanded, holding that the claims are not preempted by the combatant activities exception and reasoning that the political question issue requires a preliminary determination of which state’s law controls. View "Harris v. Kellogg Brown & Root Servs., Inc." on Justia Law