United States ex rel. Estate of Cunningham v. Millennium Laboratories

841 F. Supp. 2d 523, 2012 WL 259572, 2012 U.S. Dist. LEXIS 10347
CourtDistrict Court, D. Massachusetts
DecidedJanuary 30, 2012
DocketCivil Action No. 09-12209-JLT
StatusPublished
Cited by1 cases

This text of 841 F. Supp. 2d 523 (United States ex rel. Estate of Cunningham v. Millennium Laboratories) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts 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. Estate of Cunningham v. Millennium Laboratories, 841 F. Supp. 2d 523, 2012 WL 259572, 2012 U.S. Dist. LEXIS 10347 (D. Mass. 2012).

Opinion

MEMORANDUM

TAURO, District Judge.

I. Introduction

The Estate of Robert Cunningham (“Relator”) brings suit asserting that Defendants1 violated 31 U.S.C. § 3729(a), the federal False Claims Act (“FCA”), and similar statutes of fourteen states2 and the District of Columbia. Presently at issue is Defendant’s Motion to Dismiss the First Amended Complaint [# 36]. For the following reasons, Defendants’ Motion is ALLOWED.

II. Background

A. Factual Background

Because the issues analyzed here arise in the context of a motion to dismiss, this court examines the facts as they are presented in Relator’s Complaint,3 and construes those facts in the light most favorable to Plaintiff.4 Defendant moves to dismiss for lack of subject matter jurisdiction due to the operation of the FCA’s public disclosure bar as it existed at the [525]*525time Robert Cunningham filed the original Complaint in this suit.

The False Claims Act states that one who “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval .... is liable to the United States Government for a civil penalty. ...”5 In certain instances, an individual may bring a cause of action under the FCA as a relator on behalf of the United States.6

The public disclosure bar of the FCA states that a court lacks jurisdiction to hear such a qui tam suit, unless the Government opposes:

if substantially the same allegations or transactions as alleged in the action or claim were publicly disclosed—(i) in a Federal criminal, civil, or administrative hearing in which the Government or its agent is a party; (ii) in a congressional, Government Accountability Office, or other Federal report, hearing, audit, or investigation; or (iii) from the news media.7

In 2010, Congress amended the public disclosure bar to include the requirement that the previous public disclosure under the first sub-category occur in a federal case or hearing. Prior to the amendment, the previous public disclosure could have occurred in either a federal or state suit or hearing.8

The issue presented in Defendant’s Motion to Dismiss is whether this court had jurisdiction over Relator’s claim at the time the original complaint was filed.9 This court, therefore, presents the facts as they are related in the original Complaint, as opposed to the facts presented in the First Amended Complaint. In order to provide a complete analysis of this argument, the court first examines the facts that Defendant argues qualify as a prior, public disclosure under the public disclosure bar of the FCA.

Defendant Millennium Laboratories of California (“Millennium”) is a California company that “offers medication or prescription monitoring services for physicians.” 10 Robert Cunningham was a citizen of the United States and a resident of Massachusetts.11 In 2007 and 2008, he worked as a compliance officer for Calloway Laboratories, Inc. (“Calloway”), a competitor of Millennium. ' During his time at Calloway, Cunningham learned of Millennium’s billing practices.12 Cunningham filed the original Complaint in this suit on December 29, 2009, and he passed away on December 5, 2010.13 After Cunningham’s death, the Estate of Robert Cunningham was substituted as Relator.14

On December 24, 2009, Millennium filed a complaint against Calloway and John Does 1-50, inclusive, in the Superior Court [526]*526of California (“California suit”).15 Millennium alleged, inter alia, defamation and intentional interference with contractual relations.16 In the complaint, Millennium described its drug testing devices and its billing practices.17 Millennium alleged that Greg Williams, an account executive at Calloway, e-mailed two individuals informing them that Millennium’s billing practice allowed it to bill insurance companies and the government twice for the same service.18 In an e-mail from Stephen Schur, an account executive a Calloway, to a Millennium customer, Schur stated Millennium’s practices could lead to “potential legal exposure.” 19 Schur e-mailed another individual and stated: “The attached document should go over the [sic] all of the info that is pertinent to a Physician Billing Model (“PBM”) like Millennium’s and why it is a very bad choice for physicians to put themselves at risk for potential insurance fraud.”20 In each of these three e-mails, which Millennium attached as exhibits to the complaint, Williams and Schur explained Millennium’s billing practices. For examples, in one email, Williams wrote:

First, there are the patients and insurances being billed twice for the same service. Medicaid and Medicare frown upon being billed twice for the same thing____ Second, these in-house screens that clinics are billing the 80101 code for should be bundled, but clinics are “un-bundling” each metabolite screened for on the cup or test strip and again Medicaid and Medicare frowns upon that.21

Five days after Millennium filed its complaint against Calloway, Robert Cunningham filed the Complaint in the present case against Millennium in the United States District Court for the District of Massachusetts. When Robert Cunningham passed away, the Estate of Robert Cunningham stepped in as Relator.22

In its First Amended Complaint, Relator alleges the following. Since 2007, Millennium has provided urine drug testing services to physicians and other healthcare practitioners practicing pain management.23 Millennium informs physicians and practitioners that under its PBM, when they use Millennium’s single-specimen multi-class qualitative drug screen (“the kit”), they can bill the government or private health insurance companies for each separate drug class detected by a separate panel within the kit.24 Millennium informs physicians and practitioners [527]*527that billing for each drug class detected by a separate panel in the kit is proper under CPT code 80101QW.25 Centers for Medicare & Medicaid Services (“CMS”) explains, however, that CPT code 80101QW is the code that one should use to bill for the entire kit, not for each separate drug class detected within one kit.26

In Count I, Relator asserts that Millennium’s billing practices violated the Federal False Claims Act. Counts II-XVI assert that the same practices also violated similar state false claims acts for the states of California, Connecticut, Florida, Georgia, Illinois, Indiana, Nevada, New Jersey, New York, Oklahoma, Rhode Island, Tennessee, Texas; the Commonwealth of Virginia; and the District of Columbia.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

United States Ex Rel. Judd v. Quest Diagnostics Inc.
638 F. App'x 162 (Third Circuit, 2015)

Cite This Page — Counsel Stack

Bluebook (online)
841 F. Supp. 2d 523, 2012 WL 259572, 2012 U.S. Dist. LEXIS 10347, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-estate-of-cunningham-v-millennium-laboratories-mad-2012.