Jesse Polansky v. Executive Health Resources Inc

17 F.4th 376
CourtCourt of Appeals for the Third Circuit
DecidedOctober 28, 2021
Docket19-3810
StatusPublished
Cited by22 cases

This text of 17 F.4th 376 (Jesse Polansky v. Executive Health Resources Inc) 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
Jesse Polansky v. Executive Health Resources Inc, 17 F.4th 376 (3d Cir. 2021).

Opinion

PRECEDENTIAL

UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT __________

No. 19-3810 __________

JESSE POLANSKY, M.D., M.P.H.; THE STATE OF CALIFORNIA, THE STATE OF COLO- RADO, THE STATE OF CONNECTICUT, THE STATE OF DELAWARE, THE DISTRICT OF COLUMBIA, THE STATE OF FLORIDA,THE STATE OF GEORGIA, THE STATE OF HAWAII, THE STATE OF ILLINOIS, THE STATE OF INDIANA, THE STATE OF IOWA, THE STATE OF LOUISIANA,THE STATE OF MARYLAND, THE COMMONWEALTH OF MASSACHUSETTS, THE STATE OF MICHIGAN, THE STATE OF MINNESOTA, THE STATE OF MONTANA, THE STATE OF NE- VADA,THE STATE OF NEW JERSEY, THE STATE OF NEW MEXICO, THE STATE OF NEW YORK, THE STATE OF NORTH CAROLINA, THE STATE OF OKLA- HOMA, THE STATE OF RHODE ISLAND, THE STATE OF TENNESSEE,THE STATE OF TEXAS, THE COM- MONWEALTH OF VIRGINIA, THE STATE OF WASH- INGTON, and THE STATE OF WISCONSIN

v.

EXECUTIVE HEALTH RESOURCES INC; UNITEDHEALTH GROUP INC; UNITED HEALTHCARE SERVICES INC; OPTUM INC; OPTUMINSIGHT INC; OPTUMINSIGHT HOLDINGS LLC; COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA; YALE NEW HAVEN HOSPITAL UNITED STATES OF AMERICA

Jesse Polansky, M.D., M.P.H., Appellant. __________

On Appeal from the United States District Court for the Eastern District of Pennsylvania (D.C. No. 2-12-cv-04239) Honorable Michael M. Baylson, U.S. District Judge __________

Argued November 18, 2020

Before: JORDAN, KRAUSE, and RESTREPO, Circuit Judges

(Filed: October 28, 2021)

Nicholas C. Carullo Stephen L. Shackelford, Jr. Susman Godfrey 1301 Avenue of the Americas – 32nd Fl. New York, NY 10019

Daniel L. Geyser [ARGUED] Haynes & Boone 2323 Victory Avenue – Ste. 700 Dallas, TX 75219

William T. Jacks Fish & Richardson 111 Congress Avenue – Ste. 810 Austin, TX 78701 Counsel for Appellant

Tejinder Singh Goldstein & Russell 7475 Wisconsin Avenue – Ste. 850

2 Bethesda, MD 20814 Counsel for Amicus Appellant Taxpayers Against Fraud Education Fund

Ned I. Miltenberg National Legal Scholars Law Firm 5410 Mohican Road – Ste. 200 Bethesda, MD 20816 Counsel for Amicus Appellants Erwin Chemerinsky, National Whistleblowers Center, and Project on Government Oversight

Ethan M. Posner [ARGUED] Christopher M. Denig Matthew F. Dunn Michael M. Maya Krysten R. Moller Covington & Burling 850 10th Street, NW One City Center Washington, DC 20001

Abigail A. Hazlett Tracy Rhodes Robin P. Sumner Troutman Pepper Hamilton Sanders 3000 Two Logan Square – Ste. 1250 18th and Arch Streets Philadelphia, PA 19103 Counsel for Appellee Executive Health Resources Inc.

Jeffrey B. Clark [ARGUED] United States Department of Justice Environment & Natural Resources Division 950 Pennsylvania Avenue, NW Washington, DC 20530

Stephanie R. Marcus United States Department of Justice

3 Civil Division 950 Pennsylvania Avenue, NW – Rm. 7642 Washington, DC 20530

Charles W. Scarborough United States Department of Justice Appellate Section 950 Pennsylvania Avenue, NW – Rm. 7244 Washington, DC 20530 Counsel for Appellee United States of America

Jeffrey S. Bucholtz Jeremy M. Bylund King & Spalding 1700 Pennsylvania Avenue, NW – Ste. 200 Washington, DC 20006 Counsel for Amicus Appellee Chamber of Commerce of the United States of America

__________

OPINION OF THE COURT __________

KRAUSE, Circuit Judge.

The False Claims Act (FCA), 31 U.S.C. § 3729, et seq., empowers not just the federal government, but also private in- dividuals, to bring claims for fraud on the United States and to do so in the Government’s name in exchange for a share of the proceeds. These individuals, known as relators, are generally on the same side as the Government, which has the option early on to either intervene or allow the relator to move forward with the action on her own. But what authority does the Govern- ment have when it declined to intervene at the outset and sub- sequently opposes the relator’s suit?

To answer, we must resolve two key questions that have divided our sister circuits: (1) whether the Government in that

4 situation can move for dismissal without first intervening, and (2) if the Government properly moves for dismissal, what, if any, standard must it meet for its motion to be granted? For the reasons that follow, we conclude that the Government is required to intervene before moving to dismiss and that its mo- tion must meet the standard of Federal Rule of Civil Procedure 41(a). Because we also conclude that the District Court here acted within its discretion in granting such a motion by the Government, we will affirm the Court’s order of dismissal.

I. BACKGROUND

A. Factual Background

The False Claims Act has its roots in the Civil War, when “a series of sensational congressional investigations” un- covered widespread fraud by wartime contractors that had bilked the federal government by charging for “nonexistent or worthless goods.” United States v. McNinch, 356 U.S. 595, 599 (1958). In response, Congress not only prohibited the making of false claims to the Government, 31 U.S.C. § 3729(a)(1), and empowered the United States to seek civil remedies, id. § 3730(a); it also legislated a private enforcement mechanism, not unlike the bounty hunting common in the rough-and-tumble world of the mid-nineteenth century. That is, the statute permits private individuals, acting in the name of the Government, to assert FCA claims “for the person and for the United States Government.” Id. § 3730(b)(1). These rela- tor-initiated lawsuits, known as qui tam actions, effectively deputize citizens to act as private attorneys general, compen- sated with a share of the money recovered.1 See id. § 3730(d).

1 Qui tam is short for “qui tam pro domino rege quam pro se imposo sequitur,” which means, roughly, “who brings the action as well for the king as for himself.” United States ex rel. Kelly v. Boeing Co., 9 F.3d 743, 746 n.3 (9th Cir. 1993). A relator, acting in this capacity, can receive up to 30 percent of the funds recovered. 31 U.S.C. § 3730(d)(1)-(2).

5 This case involves such a qui tam action. Relator-Ap- pellant Dr. Jesse Polansky was an official at the Centers for Medicare and Medicaid Services (CMS) before consulting for Defendant-Appellee EHR, a “physician advisor” company that provides review and billing certification services to hospitals and physicians that bill Medicare.2 While employed as a con- sultant, Polansky became concerned that EHR was systemati- cally enabling its client hospitals to over-admit patients by cer- tifying inpatient services that should have been provided on an outpatient basis. As alleged in the complaint he eventually filed in the District Court, EHR was causing hospitals to bill the Government for inpatient stays that were not “reasonable and necessary” for diagnosis or treatment—a statutory require- ment for reimbursement under the Government’s Medicare program, 42 U.S.C. § 1395y(a)(1)(A), as explicated by CMS initially in guidance, and as of 2013, in a formal regulation, see 42 C.F.R. § 412.3(d)(1).

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