F.A.C., Inc. v. Cooperativa De Seguros De Vida De Puerto Rico

563 F.3d 1, 2009 U.S. App. LEXIS 7646, 2009 WL 960073
CourtCourt of Appeals for the First Circuit
DecidedApril 9, 2009
Docket08-1576
StatusPublished
Cited by37 cases

This text of 563 F.3d 1 (F.A.C., Inc. v. Cooperativa De Seguros De Vida De Puerto Rico) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
F.A.C., Inc. v. Cooperativa De Seguros De Vida De Puerto Rico, 563 F.3d 1, 2009 U.S. App. LEXIS 7646, 2009 WL 960073 (1st Cir. 2009).

Opinion

LYNCH, Chief Judge.

Pursuant to its inherent powers to issue sanctions for conduct undertaken in bad faith, the district court found one party to a settlement deserving of sanctions and ordered it to pay $469,000 in attorneys’ fees and costs. That party, Cooperativa de Seguros de Vida de Puerto Rico (“COS-VI”), foolishly had filed a token opposition to the sanctions motion filed by its opponent, F.A.C., Inc. (“FAC”). Only when the court allowed sanctions did COSVI belatedly produce, on motion for reconsidera *3 tion, evidence and argument that its conduct was a reasonable interpretation of its settlement obligations. The district court, in our view, was justified in not giving weight to the belated evidence and argument that sanctions were inappropriate.

Still, the court could not issue a sanctions order unless FAC hád met its burden of showing COSVI had “acted in bad faith, vexatiously, wantonly, or for oppressive reasons.” Chambers v. NASCO, Inc., 501 U.S. 32, 45-46, 111 S.Ct. 2123, 115 L.Ed.2d 27 (1991) (quoting Alyeska Pipeline Serv. Co. v. Wilderness Soc’y, 421 U.S. 240, 258-59, 95 S.Ct. 1612, 44 L.Ed.2d 141 (1975)). The court was bound by this court’s prior opinion in F.A.C., Inc. v. Cooperativa de Seguros de Vida de Puerto Rico (F.A.C. I), 449 F.3d 185 (1st Cir.2006).

The court gave four reasons in support of its finding that COSVI acted in bad faith. We find three of the four to have been erroneous, and need not reach the fourth. First, the court relied on COSVI’s initial delay in writing a letter acknowledging fraud, which the district court found to be in violation of its obligations under an oral settlement agreement. However, as we held in F.A.C. I, it was unclear that the terms of the settlement included an obligation on COSVI to write such a letter. While we affirmed the district court’s finding that such a letter was compelled by the settlement agreement, F.A.C. I, 449 F.3d at 192-93, our discussion of the question showed that the settlement terms were unclear on this point. Second, the district court concluded that COSVI “disobeyed” the court’s order to write the letter. In fact, COSVI obtained a stay of the order pending appeal and wrote the letter promptly at the conclusion of its unsuccessful efforts to appeal. Nor was there a basis for the court’s finding that five years of “protracted” litigation delays were attributable to COSVI’s bad faith; the major part of this delay resulted from the lack of clarity of the unwritten terms of settlement, and most of the remainder of the delay resulted from COS-VI’s reasonable decision to appeal on a close question. We also hold that COSVI’s appeal, which led to our earlier opinion in F.A.C. I, was not undertaken in bad faith and that there was prompt compliance with the district court’s order once it was affirmed in the F.A.C. I appeal. These holdings undercut the primary bases for the sanctions award. We vacate and remand for further proceedings consistent with this opinion.

I.

The factual background of this case is described in F.A.C. I. Id. at 187-89. Briefly stated, FAC is a consulting firm that contracted with the Puerto Rico Department of Health to recover from a federal agency unreimbursed or under-reimbursed Medicare claims, in exchange for a percentage of the recovery. COSVI is a fiscal intermediary which evaluates Medicare claims on behalf of the Centers for Medicare and Medicaid Services (“CMS”), the federal agency ultimately responsible for payment. CMS is within the U.S. Department of Health and Human Services. On May 29, 1998, FAC sued COSVI and six of its officers under RICO, 18 U.S.C. § 1962(a), (d), and Puerto Rico law for allegedly attempting to extort funds in exchange for . favorable action by COSVI on reimbursement requests FAC had made.

At issue in part was whether any fraud (alleged extortion demands by COSVI Assistant Vice President Andres Rodriguez) which occurred was the responsibility of COSVI. The parties orally settled the case on April 17, 2002, the third day of trial. They agree that the settlement obligated COSVI to write a letter to CMS in connection with FAC’s reopening requests. *4 The sanctions order stems from a disagreement, later raised, over what the letter was required to say. The language was important because CMS will not reopen claims older than three years unless “it is established that the determination or decision was procured by fraud or similar fault of any party to the determination or decision.” 42 C.F.R. § 405.1885(b)(3) (then codified at id. § 405.1885(d)).

COSVT sent a letter to CMS on May 24, 2002 that said, “[t]his request is based on facts learned by COSVI as a result of its litigation with FAC, Inc., and pursuant to 42 CFR Section 405.1885(d).” This was an oblique reference to the fraud language of the regulation. COSVI was interested in avoiding any admission that it had responsibility for fraud. 1 On June 20, 2002, CMS sent COSVI a letter stating that it refused to reopen the claims.

Starting in May 2002, FAC began to protest that COSVI was not meeting its obligations under the settlement agreement. FAC and COSVI each filed motions in the district court seeking enforcement of the settlement agreement in May and June 2002 respectively. FAC alleged that COSVI had not made the settlement payment to FAC as agreed and had not complied with other terms set forth in a post-settlement letter from FAC’s counsel, while COSVI sought to compel FAC to dismiss claims it had brought in state court. COSVI wrote a second letter on July 19, 2002 that went no further in its admissions but again mentioned § 405.1885(d). That too did not procure reopening from CMS. On August 29, 2002, the court entered an Amended Final Judgment, noting that it had “actively participated in the settlement discussions” and that it “understood the agreements reached” to include “[t]he sending of a letter by COSVI to [CMS], on behalf of FAC, Inc., requesting the reopening of the Medicare Part A reimbursement claims.” The court’s amended judgment also compelled FAC to dismiss the state lawsuit. No party appealed and the sums COSVI had deposited for the settlement were paid out.

In 2003, CMS apparently was given information about an FBI investigation into the kickbacks. In late 2003, FAC filed motions to reopen the case. See F.A.C. I, 449 F.3d at 189. FAC’s argument was that the settlement required COSVI itself to reopen the claims and that the court should order COSVI to show cause why it had not done so. The court entered an order on September 28, 2004 denying all pending motions because it considered all claims disposed of due to the parties’ settlement.

FAC filed a motion for reconsideration, arguing that COSVI was in breach of the settlement agreement because it had not fully informed CMS that fraud had occurred within COSVI.

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Bluebook (online)
563 F.3d 1, 2009 U.S. App. LEXIS 7646, 2009 WL 960073, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fac-inc-v-cooperativa-de-seguros-de-vida-de-puerto-rico-ca1-2009.