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