United States Ex Rel. Doe v. Pennsylvania Blue Shield

54 F. Supp. 2d 410, 1999 U.S. Dist. LEXIS 9212, 1999 WL 412324
CourtDistrict Court, M.D. Pennsylvania
DecidedJune 16, 1999
Docket4:CV-96-0611
StatusPublished
Cited by16 cases

This text of 54 F. Supp. 2d 410 (United States Ex Rel. Doe v. Pennsylvania Blue Shield) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania 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. Doe v. Pennsylvania Blue Shield, 54 F. Supp. 2d 410, 1999 U.S. Dist. LEXIS 9212, 1999 WL 412324 (M.D. Pa. 1999).

Opinion

MEMORANDUM

McCLURE, District Judge.

BACKGROUND:

These related actions were brought by relators Brentley and Linda Hicks under the qui tam provisions of the False Claims Act, 31 U.S.C. §§ 3729-3733, specifically § 3730. Relators filed the first complaint, docketed to No. 4:CV-96-0611, on April 5, 1996. That complaint alleged that defendant Pennsylvania Blue Shield, d/b/a Xact *413 Medicare Services, now known as High-mark Inc., used “force codes” to by-pass computer audits for claims submitted by Medicare Part B providers. An amended complaint was filed on June 12,1996.

Relators filed a second complaint, docketed to No. 4:CV-96-1308, on July 12, 1996, alleging that defendant failed to comply with instructions of the Health Care Financing Administration (HCFA) of the Department of Health and Human Services concerning the processing of laboratory claims submitted for treatment of patients with End Stage Renal Disease (ESRD).

In accordance with the False Claims Act, relators filed the complaints under seal and served them on the government, along with “voluntary disclosure statements.” The government conducted an investigation which also involved allegations by two other relators who filed complaints against defendant, as well as a problem disclosed to the government by defendant itself.

In the end, the government negotiated, and relators accepted, a global settlement of the claims with defendant for $38,500,-000.00. Of that amount, $14,000,000.00 was attributed to relators’ claims, and they were awarded 18% of the recovery, or $2,252,000.00. Relators then paid a contingency fee to their counsel of 40% of the recovery, or $1,008,000.00. It was only after the settlement was accepted by relators that the government formally intervened and moved for dismissal. The dismissal was with prejudice, with the reservation of relators’ right to petition for a statutory award of attorney’s fees.

On September 25, 1998, relators petitioned the court for the award of attorney’s fees. Since defendant opposed the award, an evidentiary hearing was conducted on April 26-28, 1999, and May 11-12, 1999. The request is now ripe for disposition.

DISCUSSION:

I. STANDARD

The relevant statute provides that a relator in a successful qui tam action “shall also receive an amount for reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys’ fees and costs. All such expenses, fees, and costs shall be awarded against the defendant.” 31 U.S.C. § 3730(d)(1). That relators are entitled to reasonable fees and costs is not in dispute. Rather, it is whether the fees claimed by relators are reasonable which is disputed by defendant.

The parties agree that the proper manner for determining the amount of the fees is the “lodestar method,” which is the general method for determining reasonable attorney’s fees in cases involving fee-shifting statutes. See, e.g., Marinelli v. City of Erie, 25 F.Supp.2d 674, 680-681 (W.D.Pa.1998) (using lodestar method under Americans with Disabilities Act, which incorporates attorney’s fees provision of Title VII); Boykin v. Bloomsburg Univ. of Pennsylvania, 905 F.Supp. 1335, 1348 (M.D.Pa.1995) (Muir, J.; Conclusion of Law No. 8; fee award against attorney who unreasonably and vexatiously multiplies proceedings under 28 U.S.C. § 1927), aff'd, 91 F.3d 122 (3d Cir.1996) (table), cert. denied sub nom. Mirin v. Eyerly, 519 U.S. 1078, 117 S.Ct. 739, 136 L.Ed.2d 678 (1997).

The proper application of the lodestar method was recited at length by the Third Circuit in Rode v. Dellarciprete, 892 F.2d 1177 (3d Cir.1990). The fee applicant has the initial burden of proving that its fee request is reasonable by submitting evidence of the number of hours worked and the hourly rate claimed; multiplying the number of hours by the rate is the starting point. Id. at 1183 (quoting Hensley v. Eckerhart, 461 U.S. 424, 433, 103 S.Ct. 1933, 76 L.Ed.2d 40 (1983)). The party opposing the fee award then has the burden of challenging the reasonableness of the fee requested, with the challenge *414 being asserted by affidavit or brief sufficiently specific to give the applicant notice of the challenge. Id. (citing Bell v. United Princeton Properties, Inc., 884 F.2d 713 (3d Cir.1989)).

Hours may be excluded if they are not reasonably expended, meaning that they are excessive, redundant, or otherwise unnecessary, that they relate to distinct claims on which the applicant did not succeed, or that the hours are inadequately documented. Id. (citing Hensley at 433, 440, 103 S.Ct. 1933; Institutionalized Juveniles v. Secretary of Public Welfare, 758 F.2d 897, 919 (3d Cir.1985)). An hourly rate is reasonable if it is consistent with the prevailing market rates in the relevant community. Id. (citing Blum v. Stenson, 465 U.S. 886, 895, 104 S.Ct. 1541, 79 L.Ed.2d 891 (1984)). This requires an assessment of the experience and skill of the applicant’s attorneys and a comparison of their rates to the rates prevailing in the community in which the attorneys practice for similar services provided by attorneys of similar skill, experience, and reputation. Id. (citing Blum at 895 n. 11, 104 S.Ct. 1541; Student Public Interest Research Group v. AT & T Bell Laboratories, 842 F.2d 1436, 1447 (3d Cir.1988)).

Once the court determines the reasonable number of hours expended and the reasonable hourly rate, it multiplies the two to obtain the lodestar, which is presumed to be the reasonable fee. Id. (citing Blum at 897, 104 S.Ct. 1541). The court then has the discretion to make certain adjustments to the lodestar, the necessity of which must be proven by the party seeking the adjustment. Id. (citing Cunningham v. City of McKeesport, 753 F.2d 262, 268 (3d Cir.1985), vacated on other grounds, 478 U.S. 1015

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Bluebook (online)
54 F. Supp. 2d 410, 1999 U.S. Dist. LEXIS 9212, 1999 WL 412324, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-doe-v-pennsylvania-blue-shield-pamd-1999.