Michele Yates v. Pinellas Hematology & Oncology, P.A.

21 F.4th 1288
Court of Appeals for the Eleventh Circuit·Decided December 29, 2021·No. 20-10276·Published·Cited by 39 cases

Opinion

[PUBLISH]

In the

United States Court of Appeals For the Eleventh Circuit

No. 20-10276

MICHELE YATES, Plaintiff-Appellee,

versus PINELLAS HEMATOLOGY & ONCOLOGY, P.A.,

Defendant-Appellant,

PRATIBHA DESAI, an individual,

Defendant.

2 Opinion of the Court 20-10276

Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 8:16-cv-00799-WFJ-CPT

Before JORDAN, NEWSOM, and TJOFLAT, Circuit Judges. JORDAN, Circuit Judge:

The jury in this qui tam case found that Pinellas Hematology & Oncology violated the False Claims Act, 31 U.S.C. § 3729 et seq., on 214 occasions, and that the United States had sustained $755.54 in damages. Following that verdict, the district court trebled the damages and imposed statutory minimum penalties of $1,177,000 ($5,500 for each of the 214 violations).

On appeal, Pinellas challenges the admission of an exhibit, the jury’s verdict on liability and damages, and the monetary award imposed by the district court. After a review of the record, and with the benefit of oral argument, we affirm in part and dismiss in part.

I

We summarize the facts in the light most favorable to the jury’s verdict. See Royal Palm Properties, LLC v. Pink Palm Properties , LLC, 950 F.3d 776, 782 (11th Cir. 2020).

20-10276 Opinion of the Court 3

A

Pinellas was a medical practice owned by Dr. Pratibha Desai . During the relevant period, Pinellas’ headquarters and primary office were located on Park Street in Saint Petersburg, Florida. We refer to this location as Park Place.

Park Place had a clinical laboratory at which, among other things, Pinellas would draw blood from patients and run laboratory tests on those blood samples. For patients who had Medicare coverage , Pinellas would seek reimbursement from the federal government for those tests.

In April of 2015, Pinellas purchased an oncology practice that was located at Bayfront Hospital in Saint Petersburg, Florida. We refer to this practice, which also had its own clinical laboratory, as Bayfront.

Under the Clinical Laboratory Improvement Amendments of 1988 and its regulations, no laboratory can conduct tests on materials derived from the human body unless it has the proper CLIA certificate. See 42 U.S.C. § 263a(b); 42 C.F.R. §§ 493.1, .3(a), .15, .43–49; Center for Medicare and Medicaid Services, Medicare Claims Processing Manual, § 70.1 (2020). Both Park Place and Bayfront had the appropriate CLIA certificates prior to the purchase of Bayfront, but Bayfront’s CLIA certificate did not transfer to Pinellas . Because each laboratory location must have its own CLIA certificate , see 42 C.F.R. § 493.43(a), Pinellas could not use either of the preexisting CLIA certificates to perform its laboratory tests at 4 Opinion of the Court 20-10276

Bayfront. Pinellas instead had to obtain a new CLIA certificate for Bayfront linking the latter to it. 1 The problem for Pinellas was that it did not have the proper CLIA certificate for Bayfront from April of 2015 until March of 2016, but it still performed tests at Bayfront during that time. The bigger problem for Pinellas was that it then submitted reimbursement claims to Medicare for those tests. And the biggest problem for Pinellas was that when Medicare rejected those claims, it altered the relevant information and resubmitted them—twice.

Michele Yates, Pinellas’ billing manager, filed a qui tam action against Pinellas and Dr. Desai. She alleged that they had violated the FCA by defrauding the United States through the submission of the Bayfront reimbursement claims to Medicare and by retaliating against her for attempting to stop their fraudulent conduct . The United States chose not to intervene. See 31 U.S.C. § 3730(b)(2).

Before trial, Pinellas filed a motion in limine to exclude Exhibit 24, a spreadsheet prepared by Ms. Yates which summarized

1 The parties debate whether Bayfront’s preexisting CLIA certificate could be transferred to Pinellas or whether Pinellas had to obtain a new CLIA certificate for Bayfront. In our view, the particular method of obtaining a CLIA certificate for Bayfront linked to Pinellas does not matter. Whether through a transfer or a brand-new application, Bayfront was required to have a CLIA certificate linked to Pinellas, and it did not have one from April of 2015 until March of 2016.

20-10276 Opinion of the Court 5

some of the allegedly fraudulent claims submitted to Medicare. The district court denied Pinellas’ motion without prejudice.

At trial, Ms. Yates told the jury that, between April and July of 2015, Pinellas had billed Medicare over 2,000 times for laboratory tests performed at Bayfront. Because Bayfront did not have a CLIA certificate at that time, those initial claims did not include a CLIA certificate number. As a result, Medicare denied those claims.

To have Medicare pay the claims, Pinellas altered the information on the claim forms to make it seem as if the laboratory tests had been conducted at Park Place, which did have a valid CLIA certificate linked to Pinellas. When it first resubmitted the claims, Pinellas added Park Place’s CLIA certificate number to the Bayfront claim forms. Medicare, however, also denied that second set of claims. So, Pinellas resubmitted the claims once again, this time changing the location of service from Bayfront’s address to Park Place’s address. Medicare paid some of the claims from the third set.

Documentary evidence corroborated Ms. Yates’ testimony.

For instance, a May 9, 2015, internal email from Lia Valentin, a Pinellas billing assistant, to Ms. Yates and others read as follows:

Michel[e], I just wanted to remind you that the claims with medicare that have labs in them the location has to be switched to pinellas park because the claim are denying until we have the clia fixed for the bayfront 6 Opinion of the Court 20-10276

office location. Im correcting the claims that came back that did not get paid & refiling them.

D.E. 201-3 at 2. Another email sent by Ms. Valentin, on July 14, 2015, stated:

I verify we have not yet added bayfront office . . . to Dr. Desai[’s] Clia number. the only two offices that are currently ok with the Clia number is park place & largo. For now any denial we receive we change the place of address to Pinellas park address and refile the claim to medicare. [T]hat way we can get the lab paid.

D.E. 201-4 at 5.

Ms. Yates moved during trial to introduce Exhibit 24—the spreadsheet—into evidence, and Pinellas did not object. She testified that Exhibit 24 showed that Pinellas had submitted 214 claims for Bayfront laboratory tests with Park Place’s CLIA certificate number and had changed the location of service to Park Place’s address . Out of that total, Medicare paid 64 claims totaling $755.54. 2

2 Ms. Yates testified that all 214 claims included in Exhibit 24 had the location of service changed to Park Place’s address. Our review of the few claim forms that are in the record on appeal, however, confirms that that is not the case. Though all the available claim forms include Park Place’s CLIA certificate number, some did not have the location of service changed to Park Place’s address. We note this discrepancy but do not address its implications, if any, because the insertion of Park Place’s CLIA certificate number by itself is sufficient to constitute a false certification under the FCA.

20-10276 Opinion of the Court 7

B

The jury found Dr. Desai not liable. As to Pinellas, the jury found it liable for having knowingly submitted 214 materially false claims to Medicare, thereby violating the FCA. The jury also found that the United States had suffered $755.54 in damages.

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Michele Yates v. Pinellas Hematology & Oncology, P.A., 21 F.4th 1288 (11th Cir. 2021).

21 F.4th 1288 (Michele Yates v. Pinellas Hematology & Oncology, P.A.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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