United States ex rel. Ganesa Rosales v. Amedisys North Carolina, L.L.C.

128 F.4th 548
Court of Appeals for the Fourth Circuit·Decided February 14, 2025·No. 24-1418·Published·Cited by 2 cases

Opinion

PUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 24-1418

UNITED STATES EX REL. GANESA ROSALES; NORTH CAROLINA EX REL. GANESA ROSALES,

Plaintiffs - Appellants,

v.

AMEDISYS NORTH CAROLINA, L.L.C., a North Carolina limited liability company; SANJAY BATISH, M.D.; BATISH MEDICAL SERVICE, PLLC,

Defendants - Appellees.

Appeal from the United States District Court for the Eastern District of North Carolina, at Wilmington. James C. Dever III, District Judge. (7:20−cv−00090−D)

Argued: December 10, 2024 Decided: February 14, 2025

Before KING, WYNN, and THACKER, Circuit Judges.

Affirmed by published opinion. Judge Wynn wrote the opinion, in which Judge King and Judge Thacker concurred.

ARGUED: John J. Beins, BEINS GOLDBERG, LLP, Chevy Chase, Maryland, for Appellants. Brian Kenneth French, NIXON PEABODY, LLP, Boston, Massachusetts, for Appellees. ON BRIEF: Samuel Ranchor Harris, III, RANCHOR HARRIS LAW, PLLC, Wake Forest, North Carolina, for Appellants. Brian T. Kelly, NIXON PEABODY LLP, Boston, Massachusetts, for Appellees.

WYNN, Circuit Judge:

The False Claims Act’s first-to-file rule allows only one relator at a time to pursue a False Claims Act claim related to a given fraud. Here, the district court dismissed the case of Plaintiff-Relator, Ganesa Rosales, against Amedisys North Carolina, LLC, and two other defendants, because another relator beat her to the punch by five years.

But Rosales argues that her claims were distinct from those in the earlier-filed complaint. She contends, in part, that the district court erred by refusing to consider new claims she asserted in an amended complaint. Although we conclude that the district court should have considered her amended complaint, we nevertheless affirm.

I.

Amedisys Holding, LLC, and its various subsidiaries provide hospice care, including for Medicare and Medicaid patients. Hospice care is, by definition, end-of-life, palliative care.

In October 2014, nurse Jackie Byers began working for Amedisys Holding’s South Carolina subsidiary and noticed what she later alleged were “fraudulent practices”— namely, that Amedisys Holding was admitting and recertifying patients “for hospice care who [did] not meet hospice requirements.” J.A. 12. 1 Months later, on August 14, 2015, Byers filed a qui tam complaint on behalf of the United States in the District of South Carolina against Amedisys Holding and its South Carolina subsidiaries (“Original Byers Complaint”). Complaint, United States ex rel. Byers v. Amedisys Holding LLC, No. 6:15-

1

Citations to the “J.A.” refer to the Joint Appendix filed by the parties in this appeal.

cv-03228 (D.S.C. Aug. 14, 2015), ECF No. 1 (sealed; available at J.A. 11–26). She brought federal and state claims, including two claims under the False Claims Act, 31 U.S.C. § 3729. As is normal in False Claims Act suits, she filed the complaint under seal to give the government time to determine whether to intervene. See 31 U.S.C. § 3730(b)(2).

The government moved for numerous extensions while it considered Byers’s complaint alongside three similar complaints filed against Amedisys Holding entities in 2016 and 2017 by relators Cathy McGee and Angela Monroe in the Southern District of West Virginia; relator Ellyn Ward in the Eastern District of New York; and relators Diane Casho and Reba Brandon in the District of Maryland. United States ex rel. Byers v. Amedisys SC LLC, No. 7:21-cv-03109-DCC, 2022 WL 4237076, at *1 & n.3 (D.S.C. Sept. 14, 2022); see Complaint, United States ex rel. McGee & Monroe v. Amedisys, Inc., No. 2:16-cv-0367 (S.D. W. Va. Jan. 15, 2016), ECF No. 1 (sealed); Complaint, United States ex rel. Ward v. Amedisys, Inc., No. 1:16-cv-5741 (E.D.N.Y. Oct. 14, 2016), ECF No. 1 (sealed); Complaint, United States ex rel. Casho & Brandon v. Amedisys Inc., No. 1:17- cv-01885 (D. Md. July 7, 2017), ECF No. 1 (sealed). 2 In April 2019, these six relators “consented to the Government’s request to consolidate and transfer the[ir] cases to the . . . District of Massachusetts.” Byers, 2022 WL 4237076, at *1. The case remained under seal at that time. See United States ex rel. Casho & Brandon v. Amedisys Inc., No. 1:19-cv-11147 (D. Mass.) (sealed).

2

While the original West Virginia and New York complaints remain under seal, their complaints are available publicly in the since-unsealed District of South Carolina litigation. See Motion to Unseal at 24, 71, 73, Byers, No. 7:21-cv-03109 (D.S.C. Oct. 4, 2021), ECF No. 85.

Meanwhile in this matter, on June 1, 2020, Rosales filed her own False Claims Act complaint under seal (“Original Rosales Complaint”). Acting on behalf of the United States and North Carolina, she sued Amedisys Holding and several of its subsidiaries, including Appellee Amedisys North Carolina, LLC (“Amedisys NC”). Rosales alleged that she “was a home hospice case manager” for Amedisys NC from November 2017 to March 2019 and that in that role she had seen Amedisys Holding and its subsidiaries (including Amedisys NC) engage in fraudulent behavior, including “unlawfully bill[ing] Medicare and Medicaid through the admission of unqualified and ineligible patients for hospice care, who are not terminal.” J.A. 29, 35. She brought three claims under the federal False Claims Act and one under the North Carolina equivalent.

On February 16, 2021, the government filed a notice declining to intervene in the consolidated Massachusetts case. Byers, 2022 WL 4237076, at *1. “Subsequently,” Maryland relators Casho and Brandon “voluntarily dismissed their case with prejudice.” Response in Opposition to Amended Motion to Dismiss at 2, Byers, No. 7:21-cv-03109 (Mar. 28, 2022), ECF No. 121. With Byers, McGee, Monroe, and Ward still acting as relators, the case returned to the District of South Carolina—where Byers had initially filed suit—and was unsealed on October 6, 2021.

On October 15, 2021, Rosales filed an amended complaint (“Amended Rosales Complaint”), adding as defendants Appellees Dr. Sanjay Batish and his practice, Batish Medical Service, PLLC. Rosales reiterated the four claims from the Original Rosales Complaint and added a fifth False Claims Act claim pursuant to the Anti-Kickback Statute.

On October 26, 2021, Byers, McGee, Monroe, and Ward filed a joint amended

complaint in the District of South Carolina against Amedisys Holding, its South Carolina subsidiary, and Amedisys Hospice LLC. Amended Complaint, Byers, No. 7:21-cv-03109 (Oct. 26, 2021), ECF No. 90 (available at J.A. 113–75). They brought five False Claims Act claims, including one referencing the Anti-Kickback Statute.

On September 14, 2022, the Byers district court granted in part and denied in part the defendants’ motion to dismiss. Byers, 2022 WL 4237076, at *1. The court noted that McGee’s claims were barred by a release in a settlement agreement. Id. at *3. And it concluded that it was required to dismiss Monroe and Ward’s claims without prejudice under the False Claim Act’s first-to-file rule because Byers had filed a complaint “based on the same material elements of fraud” before they did. 3 Id. at *4. The court also dismissed one of Byers’s claims but otherwise denied the motion to dismiss Byers’s complaint. Id. at *4–6. Byers’s case remains pending in the District of South Carolina.

Regarding the matter before us, on May 24, 2023, the United States and North Carolina filed a notice in Rosales’s case declining to intervene. The district court then partially unsealed this case. The three Appellees (Amedisys NC, Dr. Batish, and his practice) moved to dismiss, after which Rosales voluntarily dismissed all other defendants. In April 2024, the district court dismissed Rosales’s federal claims against the three Appellees without prejudice for lack of jurisdiction pursuant to the first-to-file rule— because of Byers’s earlier-filed action—and declined to exercise supplemental jurisdiction

3

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United States ex rel. Ganesa Rosales v. Amedisys North Carolina, L.L.C., 128 F.4th 548 (4th Cir. 2025).

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