United States Ex Rel. Williams v. Renal Care Group, Inc.

696 F.3d 518, 2012 WL 4748104, 2012 U.S. App. LEXIS 20806
CourtCourt of Appeals for the Sixth Circuit
DecidedOctober 5, 2012
Docket11-5779
StatusPublished
Cited by53 cases

This text of 696 F.3d 518 (United States Ex Rel. Williams v. Renal Care Group, Inc.) 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. Williams v. Renal Care Group, Inc., 696 F.3d 518, 2012 WL 4748104, 2012 U.S. App. LEXIS 20806 (6th Cir. 2012).

Opinions

COLE, J., delivered the opinion of the court in which, COOK, J., and ROSEN, C. D.J., joined. ROSEN, C. D.J. (pp. 533-35), delivered a separate concurring opinion.

OPINION

COLE, Circuit Judge.

Renal Care Group, Inc., a dialysis provider, created a wholly-owned subsidiary to take advantage of loopholes in the Medi[521]*521care regulatory scheme that would permit it to increase profits. The United States, by and through its relators, brought suit against Renal Care Group, its subsidiary, and its successor, alleging that such actions constituted a number of False Claims Act violations. The district court granted summary judgment in favor of the United States as to the main claim, Count One— the only claim upon which damages were sought — and then proceeded to enter summary judgment as to the ancillary claims as well, though without explanation. For the reasons set forth below, we REVERSE the district court’s judgments as to Counts One and Two, and GRANT summary judgment on those counts in favor of the defendants. Further, we REVERSE the district court’s judgments as to all remaining counts and REMAND for proceedings consistent with this opinion, but DENY the defendants’ motion for reassignment of this case to another district judge.

I. BACKGROUND

A. Factual Background

Renal Care Group, Inc. (RCG) was, for all times relevant to the instant case, the parent company of Renal Care Group Supply Company (RCGSC). Fresenius Medical Care Holdings, Inc., (Fresenius) is the successor-in-interest to both RCG and RCGSC. RCG provided dialysis to patients with end-stage renal disease (ESRD) at more than 260 RCG dialysis facilities, in addition to providing dialysis supplies and services to home dialysis patients. RCGSC, meanwhile, supplied only dialysis equipment to home dialysis patients. Both entities submitted claims for payment for these services to Medicare.

1. End-stage renal disease and Medicare

ESRD occurs when the kidneys are no longer able to function at a level needed for daily life because they are unable to remove waste and excess water from the body. Persons suffering from ESRD must undergo some form of kidney disease treatment, which may include either hemodialysis or peritoneal dialysis. Patients undergoing hemodialysis use a machine that removes blood from the body, runs it through a filter, and then returns the blood to the body. In peritoneal dialysis, a dialysis solution travels through a catheter into a patient’s abdomen and draws wastes, chemicals, and extra water from blood vessels in the peritoneal membrane. The solution is then removed, and the process repeated. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD), which requires no machine, and continuous cycler-assisted peritoneal dialysis (CCPD), in which a machine called a “cycler” fills and empties the abdomen while the patient sleeps.

In 1972, Congress expanded Medicare to provide insurance coverage for patients suffering from ESRD, regardless of their age. Pub. L. No. 92-603, § 2991, 86 Stat. 1329, 1463-64 (1972). In 1978, citing a need to lower costs, Congress amended the program to permit Medicare to reimburse dialysis facilities for the cost of home dialysis equipment. Pub. L. No. 95-292, § 2, 92 Stat. 307, 308 (1978). Initially, all services, including home dialysis, were reimbursed at a uniform composite weighted payment. Pub. L. No. 97-35, § 2145(a), 95 Stat. 357, 799-800 (1981). This reimbursement rate is known as “Method I” reimbursement.

The uniform Method I reimbursement rate did not apply to independent companies that provided only equipment and supplies (but not services) directly to home dialysis patients. Those companies were reimbursed under a “Method II” protocol, [522]*522whereby payment is made on a “fee-for-service basis, which is the reasonable charge method used for [Medicare] Part B services.” 57 Fed. Reg. 54,179 (Nov. 17, 1992). Method II reimbursements eventually became more expensive than Method I reimbursements. See H.R. Conf. Rep. No. 101-386, reprinted in 1989 U.S.C.C.A.N. 3018, 3429. Congress eventually capped Method II payments at the Method I rate, except for payments for supplies for CCPD treatments, which were capped at 130% of the Method I rate. 42 U.S.C. § 1395rr (b)(7).

Congress further restricted Method II reimbursements with 42 U.S.C. § 1395rr(b)(4)(B), which permits such reimbursements only “to a supplier of home dialysis supplies and equipment furnished to a patient whose self-care home dialysis is not under the direct supervision of an approved provider of services or renal dialysis facility----” (emphasis added). This was clarified in 1994, when Congress required that Method II payments may only go to an entity that is not “a provider of services [or] a renal dialysis facility....” 42 U.S.C. § 1395rr(b)(l); see also 42 C.F.R. § 400.202 (defining a supplier as “a physician or other practitioner, or an entity other than a provider, that furnishes health care services under Medicare”). Such an entity must obtain a supplier number before it can bill Medicare for supplies and equipment, 42 U.S.C. § 1395m(j)(l)(A), and may only be reimbursed if it is “not a Medicare approved dialysis facility,” 42 C.F.R. § 414.330(a)(2)(i). In 2010, the Secretary for Health and Human Services eliminated Method II reimbursements altogether. 75 Fed. Reg. 49,030, 49,058 (Aug. 12, 2010).

2. Conversion of RCG patients to RCGSC patients

RCGSC had its basis in a 1997 e-mail written by Russell Dimmitt, RCG’s director of material management, which compared Method I and Method II reimbursements. The e-mail made clear that Method II reimbursements were substantially higher, and would result in less overhead. A subsequent memorandum to RCG associates directed them to “convert CCPD Medicare patients to method 2.” The memorandum also instructed associates to place new CCPD patients on Method II, even those who might initially be CAPD patients (which had an equivalent reimbursement rate for Method I CAPD patients), because the companies would “plan to convert them later.”

RCGSC was formed in 1998 as a wholly-owned subsidiary of RCG, and RCG employees, officers, and directors all held key roles in RCGSC’s corporate structure. Gary Brukardt, RCG’s chief executive officer, was also RCGSC’s president. The companies shared office space, payroll, insurance benefits, contracts, and human resource services. Money deposited into RCGSC’s account was swept into RCG’s corporate account nightly, RCG’s accounts payable department paid RCGSC’s supply vendors, and RCGSC’s director could not spend RCGSC’s funds. All RCGSC employees were managed or directed by RCG employees.

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696 F.3d 518, 2012 WL 4748104, 2012 U.S. App. LEXIS 20806, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-williams-v-renal-care-group-inc-ca6-2012.