United States, ex rel. Sanborn v. Athenahealth, Inc.

56 F.4th 152
CourtCourt of Appeals for the First Circuit
DecidedDecember 21, 2022
Docket22-1245P
StatusPublished
Cited by9 cases

This text of 56 F.4th 152 (United States, ex rel. Sanborn v. Athenahealth, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the First 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. Sanborn v. Athenahealth, Inc., 56 F.4th 152 (1st Cir. 2022).

Opinion

United States Court of Appeals For the First Circuit

No. 22-1245

UNITED STATES, ex rel. CHERYL LOVELL and WILLIAM MCKUSICK,

Plaintiffs, Appellants,

UNITED STATES, ex rel. GEORDIE SANBORN; STATE OF VERMONT, STATE OF CALIFORNIA, STATE OF COLORADO, STATE OF DELAWARE, STATE OF FLORIDA, STATE OF GEORGIA, STATE OF HAWAII, STATE OF ILLINOIS, STATE OF INDIANA, STATE OF IOWA, STATE OF MARYLAND, COMMONWEALTH OF MASSACHUSETTS, STATE OF MICHIGAN, STATE OF MINNESOTA, STATE OF MONTANA, STATE OF NEVADA, STATE OF NEW JERSEY, STATE OF NEW YORK, STATE OF NORTH CAROLINA, STATE OF OKLAHOMA, STATE OF RHODE ISLAND, STATE OF TEXAS, STATE OF WISCONSIN, DISTRICT OF COLUMBIA, COMMONWEALTH OF VIRGINIA, STATE OF NEW MEXICO, STATE OF TENNESSEE, STATE OF WASHINGTON, STATE OF CONNECTICUT, STATE OF LOUISIANA, ex rel. CHERYL LOVELL AND WILLIAM MCKUSICK,

Plaintiffs,

v.

ATHENAHEALTH, INC.,

Defendant, Appellee,

JOHN DOES 1-10,

Defendants.

No. 22-1246

UNITED STATES, ex rel. GEORDIE SANBORN,

Plaintiff, Appellant,

UNITED STATES, ex rel. CHERYL LOVELL and WILLIAM MCKUSICK; STATE OF VERMONT, STATE OF CALIFORNIA, STATE OF COLORADO, STATE OF DELAWARE, STATE OF FLORIDA, STATE OF GEORGIA, STATE OF HAWAII, STATE OF ILLINOIS, STATE OF INDIANA, STATE OF IOWA, STATE OF MARYLAND, COMMONWEALTH OF MASSACHUSETTS, STATE OF MICHIGAN, STATE OF MINNESOTA, STATE OF MONTANA, STATE OF NEVADA, STATE OF NEW JERSEY, STATE OF NEW YORK, STATE OF NORTH CAROLINA, STATE OF OKLAHOMA, STATE OF RHODE ISLAND, STATE OF TEXAS, STATE OF WISCONSIN, DISTRICT OF COLUMBIA, COMMONWEALTH OF VIRGINIA, STATE OF NEW MEXICO, STATE OF TENNESSEE, STATE OF WASHINGTON, STATE OF CONNECTICUT, STATE OF LOUISIANA, ex rel. CHERYL LOVELL AND WILLIAM MCKUSICK,

APPEALS FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS

[Hon. Nathaniel M. Gorton, U.S. District Judge]

Before

Barron, Chief Judge, Lynch and Gelpí, Circuit Judges.

Hyland Hunt, with whom Ruthanne M. Deutsch, Deutsch Hunt PLLC, Suzanne E. Durrell, and Whistleblower Law Collaborative LLC were on brief, for appellants Lovell and McKusick. Andrew D. Schlichter, with whom Joel D. Rohlf and Schlichter Bogard & Denton, LLP were on brief, for appellant Sanborn. Sarah E. Walters, with whom Mark W. Pearlstein, Natasha L. Dobrott, and McDermott Will & Emery LLP were on brief, for appellee. December 21, 2022 LYNCH, Circuit Judge. In these two different qui tam

cases in which the United States executed a settlement agreement

with defendant AthenaHealth, Inc. ("Athena") and multiple

relators, relators Cheryl Lovell and William McKusick appeal from

the district court's denial of their entire claim for attorneys'

fees under the False Claims Act ("FCA"), 31 U.S.C. § 3729 et seq.

The district court did so on the basis that such fees were

available only to first-to-file relators and Lovell and McKusick

were not first-to-file relators. United States v. AthenaHealth,

Inc., No. 17-cv-12125, 2022 WL 658654, at *4-5 (D. Mass. Mar. 3,

2022).

The first-to-file relator, Geordie Sanborn, appeals from

the omission of certain claimed fees from his award of attorneys'

fees. Both appeals present questions of first impression for this

court.

We affirm as to Lovell and McKusick on narrow reasoning,

confined to the facts concerning the provisions of the government's

settlement agreement. We conclude that Lovell and McKusick did

not receive a relator's share and so are not entitled to attorneys'

fees. We leave for another day the issue of whether such fees are

restricted to first-to-file relators. We also do not address

different factual situations where the settlement agreement

reached by the United States provides for payment of relator's

shares to multiple relators. We affirm as to Sanborn, rejecting

- 4 - his argument under the text of 31 U.S.C. § 3730(d)(1) that he may

be allowed fees associated with his claim in which the government

did not intervene.

I.

A.

The False Claims Act imposes liability on any person

who, inter alia, "knowingly presents, or causes to be presented,

a false or fraudulent claim for payment or approval," 31 U.S.C.

§ 3729(a)(1)(A), "to an officer, employee, or agent of the United

States," id. § 3729(b)(2)(A)(i). The statute authorizes two types

of actions. The government can bring a civil action against the

alleged false claimant. Id. § 3730(a). Alternatively, a private

person (a "relator") can bring a qui tam civil action in the

government's name "for the person and for the United States

Government." Id. § 3730(b). Qui tam plaintiffs must file their

complaints under seal and serve a copy of the complaint, along

with all material evidence, on the government. Id. § 3730(b)(2).

The government may then decide to intervene, "in which case the

action shall be conducted by the Government." Id. § 3730(b)(4)(A).

If the government does not intervene, the qui tam plaintiff "shall

have the right to conduct the action." Id. § 3730(b)(4)(B). A

plaintiff's complaint may remain sealed for an extended period

while the government investigates the allegations prior to making

its intervention decision. See id. § 3730(b)(2)-(3).

- 5 - B.

We recite only the necessary undisputed facts. Athena

is a medical software company that sells health record services

and other cloud-based products. Relator Sanborn works in business

development and sales for one of Athena's competitors. Relators

Lovell and McKusick operate a home-healthcare service that was one

of Athena's clients.

On October 30, 2017, Sanborn filed a sealed qui tam

complaint against Athena. The complaint alleged that Athena had

operated incentive programs to induce purchases of Athena's

services in violation of the Anti-Kickback Statute, 42 U.S.C.

§ 1320a-7b(b) (the "Kickback Claim"). Sanborn's complaint also

alleged that Athena marketed its electronic health record

technology with a false guarantee of compliance with federal

certification requirements (the "EHR Compliance Claim").

Roughly two months later, on December 21, 2017, Lovell

and McKusick filed a separate qui tam complaint against Athena.

They amended that complaint on April 18, 2018. Like Sanborn,

Lovell and McKusick alleged that Athena's incentive programs

violated the Anti-Kickback Statute (again, the "Kickback Claim").

They also alleged that Athena's billing software submitted false

claims for services (the "Billing Claim").

The government conducted an investigation over the next

three years. On September 22, 2020, the government reached an

- 6 - agreement in principle with Athena to settle all the claims. At

some point in December 2020, both sets of relators reached an

agreement between themselves as to how to allocate any relator's

share from the anticipated settlement. The terms of this agreement

are not in the record. On January 22, 2021, the government filed

a notice in court that it was electing to intervene in part in

both Sanborn's case and Lovell and McKusick's case. The

government's complaint in intervention, filed on January 25, 2021,

intervened as to the relators' Kickback Claims.

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56 F.4th 152, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-sanborn-v-athenahealth-inc-ca1-2022.