United States Ex Rel. Antoon v. Cleveland Clinic Foundation

788 F.3d 605, 2015 FED App. 0120P, 2015 U.S. App. LEXIS 9734, 2015 WL 3620519
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 11, 2015
Docket13-4348
StatusPublished
Cited by22 cases

This text of 788 F.3d 605 (United States Ex Rel. Antoon v. Cleveland Clinic Foundation) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States Ex Rel. Antoon v. Cleveland Clinic Foundation, 788 F.3d 605, 2015 FED App. 0120P, 2015 U.S. App. LEXIS 9734, 2015 WL 3620519 (6th Cir. 2015).

Opinions

LAWSON, D.J., delivered the opinion of the court in which McKEAGUE, J., joined and GIBBONS, J., joined in part and in the result. GIBBONS, J. (pp. 620-22), delivered a separate concurring opinion.

OPINION

DAVID M. LAWSON, District Judge.

When Colonel David Antoon (United States Air Force, retired) learned that he needed prostate surgery, he researched treatment options and specialists, which led him to the Cleveland Clinic and defendant Dr. Jihad Kaouk. Col. Antoon interviewed Dr. Kaouk and arranged for him to perform the operation, or so he thought. When Col. Antoon experienced complications following the surgery, his further investigation caused him to suspect that Dr. Kaouk did not actually perform the surgery, and passed off the major duties to a surgical resident. Based on that suspicion, Col. Antoon lodged complaints with several individuals and agencies, and he filed a medical malpractice action in state court, which was dismissed voluntarily. Finding no satisfaction, Col. Antoon brought the present lawsuit as a relator under the qui tarn provisions of the False Claims Act (FCA), premised on the theory that Dr. Kaouk billed the government for work he did not perform, and promoted the robotic surgical device he recommended in violation of the anti-kickback statute. The United States declined to intervene, and the district court granted the defendants’ motion to dismiss, after denying Col. Antoon leave to file a second amended complaint. Although we do not necessarily agree with some of the district court’s grounds for dismissing the case and declining the amendment, we do find that Col. Antoon cannot maintain a false claims action against the defendants because of a jurisdictional bar. Col. Antoon does not have any direct and independent knowledge of the information upon which his fraud allegations are based; therefore he cannot qualify as an original source of that information, and cannot establish standing as a qui tarn plaintiff under the FCA. On that basis, we affirm the judgment of the district court.

I. Facts and proceedings

Col. Antoon began this action by filing a pro se complaint under seal in the district court on behalf of himself and his wife. He followed that with an amended complaint. After the government declined to intervene and the lawsuit was served, the defendants filed a motion to dismiss under Federal Rule of Civil Procedure 12(b)(1) and (6). Col. Antoon then obtained counsel, who responded to the motion and moved for leave to file a second amended complaint.

A. First amended complaint

In the first amended complaint, Col. An-toon alleged that he met with Dr. Kaouk on December 6, 2007 to discuss surgical options to treat prostate cancer. At that meeting, Dr. Kaouk informed him that “robotic surgery was the safest surgical option and provided the best surgical outcomes for continence and potency.” [610]*610Moreover, Dr. Kaouk represented that “only he, not doctors in training, would perform [Col. Antoon’s] major surgery.” Col. Antoon purportedly added language to the informed consent document that only Dr. Kaouk was authorized to perform the plaintiffs surgery.

On January 8, 2008, Col. Antoon underwent surgery, which resulted in multiple permanent complications causing disability and loss of employment. Col. Antoon alleges that he “did not see Jihad Kaouk in the operating room,” and told a surgical resident, Dr. Raj Goel that only Dr. Kaouk was authorized to perform his surgery. Dr. Goel called Dr. Kaouk twice from the operating room to express Col. Antoon’s concerns and then directed surgery to proceed over Col. Antoon’s objections. Dr. Kaouk called Ms. Antoon over the phone to say he “had trouble” and “got stuck,” apparently in an effort to explain the lengthy surgery.

On January 15, 2008, Col. Antoon returned to the hospital for post-surgery procedures. A physician’s assistant removed Col. Antoon’s surgical drain and catheter, but no physician or resident met with him. Col. Antoon alleged that' he “began experiencing multiple complications” after the visit, which he communicated to Dr. Kaouk, but were not documented in his chart.

Since July 2009, Col. Antoon alleged that he lodged complaints with the deve-la^ Clinic Foundation (CCF), the Ohio Department of Health, the State Medical Board of Ohio, the federal Centers for 'Medicare/Medicaid Services (CMS), the Joint Commission on Accreditation, and government insurance programs TRI-CARE and the Civil Health and Medical Program of the Uniformed Services (CHAMPUS). He submitted multiple Freedom of Information Act (FOIA) requests to state and federal agencies. He also filed a medical malpractice action in the Cuyahoga County, Ohio Court of Common Pleas. Other former patients of Dr. Kaouk contacted the plaintiff after a newspaper article was published about Col. An-toon’s civil complaint.

The CCF ombudsman, Daniel DiCello, investigated Col. Antoon’s complaint and concluded that there was “no indication that anything was done outside of the standard of care.” The ombudsman confirmed that “Staff Surgeon # 16 [Jihad Kaouk] performed all critical points of the surgical procedure, consistent with the information provide[d] to the patient prior to surgery” and “the surgical fellow [Raj Goel] was limited to non-critical points of the surgical procedure, as [is] typically the case with procedures of this type.” But Col. Antoon insisted that CCF’s findings were “false and intentionally misleading.” Col. An-toon maintained that many records, documents, and communications were concealed, disappeared, or redacted to conceal complications from the surgery.

The amended complaint states a single claim under the FCA; it appears that Col. Antoon’s theory was that CCF and Dr. Kauok violated several provisions of the TRICARE manual when submitting the bill for Col. Antoon’s prostate surgery. The essence of the false claim was the submission of a CMS-1500 claim form for surgery by Dr. Kauok, when in truth the surgery was performed by an unsupervised surgical resident. The relators also alleged that Dr. Kauok, the CCF, and device manufacturer Intuitive violated the Medicare and Medicaid Patient Protection Act by falsely promoting the efficacy of the robotic surgical device Dr. Kauok recommended when the doctor received compensation from Intuitive. Presumably, they meant to cite the anti-kickback provision in 42 U.S.C. § 1320a-7b(b)(2). The relators [611]*611made similar claims against the other defendants.

B. Proposed second amended complaint

The proposed second amended complaint, which was rejected by the district court on futility grounds, was considerably more detailed; it spanned 116 pages, contained 569 paragraphs, and included over 700 exhibits. But the theory of liability was the same: the defendants violated a condition of payment under the TRICARE and CHAMPUS programs when they submitted a CMS-1500 claim form and certified that the surgery was performed personally by Dr. Kaouk. The condition of payment was found in the TRICARE reimbursement manual. The plaintiffs alleged that several medical records do not indicate that Dr. Kaouk was present for the surgery or that the records were altered or signed weeks after the surgery to cover up multiple investigations for fraud.

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Cite This Page — Counsel Stack

Bluebook (online)
788 F.3d 605, 2015 FED App. 0120P, 2015 U.S. App. LEXIS 9734, 2015 WL 3620519, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-antoon-v-cleveland-clinic-foundation-ca6-2015.