No. 20-286

United States, ex rel. Stacey L. Janssen, as Special Administrator of the Estate of Megen Corin Duffy v. Lawrence Memorial Hospital

Lower Court: Tenth Circuit
Docketed: 2020-09-04
Status: Denied
Type: Paid
Response Waived
Tags: circuit-split false-claims-act materiality medicare medicare-reimbursement patient-arrival-times quality-reporting reimbursement statutory statutory-quality-reporting
Key Terms:
SocialSecurity JusticiabilityDoctri
Latest Conference: 2020-09-29
Question Presented (AI Summary)

Whether a Medicare provider's knowing falsifications of hospital patient arrival times, known by the hospital to be material to statutory quality reporting programs directly affecting the hospital's Medicare reimbursement rate, are immaterial under the False Claims Act

Question Presented (OCR Extract)

QUESTIONS PRESENTED Universal Health Services, Inc. v. Escobar, 136 S.Ct. 1989, 2002 (2016) held that “[uJnder any understanding of the concept, materiality ‘look[s] to the effect on the likely or actual behavior of the recipient of the alleged (quoting 26 R. Lord, Williston on Contracts § 69:12, p. 549 (4th ed. 2003) (Williston)). The Court recognized that materiality, as employed in federal statutes including the False Claims Act, “descends from ‘common law antecedents’” (quoting Kungys v. United States, 485 U.S. 759, 769 (1988)), and discussed those antecedents in tort and contract law. Id. (citing Restatement (Second) of Torts § 538, at 80 and Restatement (Second) of Contracts § 162(2), and Comment c, pp. 439, 441 (1979)). The Petition presents the following questions: Whether a Medicare provider’s knowing falsifications of hospital patient arrival times, known by the hospital to be material to statutory quality reporting programs directly affecting the hospital’s Medicare reimbursement rate, are immaterial under the False Claims Act, as held by the Tenth Circuit in conflict with the Fifth, Eighth, Ninth, and Eleventh Circuits, absent additional evidence of impact on the payment behavior of the decisionmaking agency. Whether change in payment behavior of the Government is the controlling factor in determining materiality under the False Claims Act, as held by the Tenth Circuit, or whether ii QUESTIONS PRESENTED—Continued determining materiality instead requires a holistic analysis allowing for objective and subjective evidence, as held by the First, Fourth, Fifth, Sixth, Seventh, Eighth, Ninth, and Eleventh Circuits.

Docket Entries

2020-10-05
Petition DENIED.
2020-09-09
DISTRIBUTED for Conference of 9/29/2020.
2020-09-04
Waiver of right of respondent Lawrence Memorial Hospital to respond filed.
2020-08-27
Petition for a writ of certiorari filed. (Response due October 5, 2020)

Attorneys

Lawrence Memorial Hospital
Andrew R. RamirezSpencer Fane LLP, Respondent
Andrew R. RamirezSpencer Fane LLP, Respondent