Alan Cooper v. Pottstown Hospital Co LLC

651 F. App'x 114
CourtCourt of Appeals for the Third Circuit
DecidedJune 10, 2016
Docket15-1748
StatusUnpublished
Cited by1 cases

This text of 651 F. App'x 114 (Alan Cooper v. Pottstown Hospital Co LLC) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alan Cooper v. Pottstown Hospital Co LLC, 651 F. App'x 114 (3d Cir. 2016).

Opinion

OPINION *

NYGAARD, Circuit Judge.

Alan Cooper appeals the District Court’s grant of motions to dismiss brought' by Pottstown Hospital Co. LLC (d.b.a. Potts-town Memorial Medical Center) and Community Health Systems Professional Services Corp (CHSPSC). 1 He contends that his complaint is well-pleaded, asserting claims under 42 U.S.C. § 1320a-7b, the Medicare and Medicaid Patient Protection Act of 1987 (Anti-Kickback Statute), and 31 U.S.C. §§ 3729-3733, the False Claims Act. We will affirm the order of the District Court.

This opinion does not have any prece-dential value. Therefore, our discussion of the case is limited to covering only what is necessary to explain our decision to the parties.

A cause of action under the False Claims Act must prove that the defendant made a claim, or caused a claim to be made, for payment by the government that the defendant knew was false or fraudulent. United States ex rel. Wilkins v. United Health Grp., Inc., 659 F.3d 295, 305 (3d Cir.2011). The Anti Kickback Statute includes the following:

(1) Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind — (A) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program.

42 U.S.C.A. § 1320a-7b(b)(l)-(b)(l)(A). Violations of the Anti-Kickback' Statute, under the Affordable Care Act, “constitute a false or fraudulent claim for purposes of [the False Claims Act].” 42 U.S.C. § 1320a-7b(g).

Cooper alleges that Pottstown violated the Anti-Kickback Statute by contracting twice with him to be an on-call physician. He asserts that, although he was unaware of the scheme, the real purpose of . these contracts was to ensnare him in a scheme in which Pottstown paid him for on-call services in exchange for his exclusive referral of Medicare-eligible patients to Pottstown. Cooper further alleges that Pottstown falsely certified compliance with the Anti-Kickback Statute each time it submitted a claim for payment to the government arising from services to Medicare patients that he referred. U.S. ex rel. Wilkins, 659 F.3d at 304. Finally, he asserts that CHSPSC is liable for its role in. authorizing and encouraging the on-call contracts that Cooper claims grounded the kickback scheme. ..

*116 “To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Bell All. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). Moreover, “[i]n alleging fraud or mistake, a party must state with particularity the circumstances constituting fraud or mistake. Malice, intent, knowledge, and other conditions of a person’s mind may be alleged generally.” Fed. R. Civ. P. 9(b). As for causes of action under the False Claims Act “it is sufficient for a plaintiff to allege ‘particular details of a scheme to submit false claims paired with reliable indicia that lead to a strong inference that claims were actually submitted.’ ” Foglia v. Renal Ventures Mgmt, LLC, 754 F.3d 153, 156 (3d Cir.2014) (quoting United States ex rel. Grubbs v. Kanneganti, 565 F.3d 180, 190 (5th Cir.2009).).

The simple fact that a payment was made to Cooper as remuneration (implying that services were rendered) is not fatal to his claim. United States v. Greber, 760 F.2d 68, 71 (3d Cir.1985). However, as the District Court correctly highlighted, the problem with Cooper’s complaint is that he avers a contractual relationship between Pottstown and himself that is indistinguishable from a standard business transaction. His claim relies heavily on the timing of his dismissals to Pottstown’s discovering (in the case of the first contract) that he owned an interest in, and was referring patients to, a medical practice that was competing with Pottstown; 2 and (in the case of the second contract) that he was employed by St. Joseph’s Medical Center, another hospital in the same geographic locale as Pottstown. Cooper also avers that he was the only on-call surgeon who was terminated in both instances. He is convinced that this shows Pottstown retaliated against him because he was not referring Medicare patients exclusively to Pottstown. Cooper says this is enough to survive a motion to dismiss.

However, two problems undermine Cooper’s cause. First, as we state above, he does not aver any facts to enable the Court to plausibly distinguish the relationship between Pottstown and himself from a typical arms-length contract in which compensation is paid solely in exchange for on-call services. He does not allege that, at the time that the contracts were executed, Pottstown did or said anything to ground an inference that it intended to induce him to exclusively refer patients to Pottstown. Nor does he aver, for instance, that Potts-town had no need for his on-call medical services or that his compensation greatly exceeded market expectations. His complaint is devoid of any indicia of Potts-town’s intent to operate a kickback scheme.

Instead, Cooper relies on characterizations of the contract as a “reward” by Pottstown and his termination as a “punishment.” *117 3 But, attaching eonclusory labels to ordinary, lawful acts of business' does not suffice. He also asserts that Medicare claims submitted from services he rendered ground a claim of Anti-Kickback Statute violations because Pottstown falsely certified that these claims complied with the Anti-Kickback Statute. U.S. ex rel. Wilkins, 659 F.3d at 305. However, such violations would occur only in instances where there were, in fact, kickbacks relating to Medicare patients. Cooper provides nothing beyond eonclusory statements to the effect that Pottstown received large Medicare reimbursements from the government that flowed from illegal kickbacks. This is insufficient.

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651 F. App'x 114, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alan-cooper-v-pottstown-hospital-co-llc-ca3-2016.