United States of America, Ex Rel. Maxine Jones v. Horizon Healthcare Corporation

160 F.3d 326, 1998 WL 774104
Court of Appeals for the Sixth Circuit·Decided January 11, 1999·No. 97-1635·Published·Cited by 46 cases

Opinions

CLAY, J., delivered the opinion of the court, in which MOORE, J., joined. GILMAN, J. (pp. 335-337), delivered a separate opinion concurring in the result.

OPINION

CLAY, Circuit Judge.

Plaintiff-Appellant Maxine Jones brought this qui tam action under the Federal False Claims Act, 31 U.S.C. §§ 3729-3733 (1994), against Defendant-Appellee Horizon Healthcare Corporation on the basis of Horizon Healthcare’s allegedly fraudulent activities against the United States. The district court granted summary judgment in favor of Horizon Healthcare for lack of subject matter jurisdiction. For the reasons set forth below, we hereby AFFIRM the ruling of the district court.

I.

Plaintiff-Appellant Maxine Jones (“Appellant”) was hired by Defendant-Appellee Horizon Healthcare Corporation (“Appellee”) as a patient care services consultant in November of 1992. Her job responsibilities included reviewing Medicare claim forms which sought reimbursement for services performed at several of Appellee’s skilled health care facilities in Michigan and Wisconsin.

Appellant claims that while conducting a claims review in March of 1993, she discovered that several of the claim forms prepared by Appellee’s administration and employees were incorrect because the services allegedly performed did not correspond with the patients’ files and the instructions of the medical staff. Appellant alleges that she informed management of the fraudulent claims and, as a result of her actions, her employment was terminated three months later. After her termination, Appellant applied for [329] unemployment benefits with the Michigan Employment Security Commission and provided a statement detailing the reasons for her discharge, including her allegation that Appellee was preparing, and perhaps filing, false Medicare claims. Appellant also allegedly contacted someone at the Michigan Department of Public Health about her allegations of fraud.

On September 16, 1993, Appellant filed a complaint in the United States District Court for the Eastern District of Michigan, pursuant to diversity jurisdiction, under the Michigan Whistleblower’s Protection Act, Mioh. Comp. Laws Ann. §§ 15.361-369 (West 1994) CWPA”), asserting that she was wrongfully terminated after she discovered that false reimbursement claims had been prepared by Appellee. Appellant claims that she did not know at that time whether the forms actually had been submitted in violation of Medicare guidelines, because she had only been told that the matter was “being taken care of’ when she had complained to management.

On April 21, 1994, Appellant filed a second complaint in the United States District Court for the Eastern District of Michigan against Appellee relating to the fraudulent Medicare forms, this one a qui tam action1 pursuant to the Federal False Claims Act, 31 U.S.C. §§ 3729-3733 (1994) (“FCA”). The FCA complaint, which was filed under seal as required by the statute, specifically alleged that Appellee had submitted the false Medicare forms to the government for reimbursement. Appellant claims that it was during the interim between the filing of the two complaints that she was able to determine that the false claims had been submitted, which was necessary for a violation of the FCA. On May 2, 1994, the FCA complaint was served upon the Attorney General of the United States, but the Department of Justice ultimately declined to intervene.

Appellee filed a motion for summary judgment in the FCA action on December 20, 1996. The district court granted Appellee’s motion on March 11,1997, and dismissed the complaint for lack of subject matter jurisdiction under the FCA, which prohibits qui tam actions “based upon” public disclosures of fraud unless the plaintiff is an “original source” of the information. The district court later denied Appellant’s motion for reconsideration and clarified that the dismissal of the FCA action was without prejudice to the United States. This timely appeal followed.2

II.

This court’s review of a district court’s dismissal of a Federal False Claims Act case on the basis of lack of subject matter jurisdiction is reviewed de novo. United States ex rel. McKenzie v. Bellsouth Telecomms., Inc., 123 F.3d 935, 938 (6th Cir.1997), cert. denied, - U.S. -, 118 S.Ct. 855, 139 L.Ed.2d 755 (1998). All factual allegations in the complaint are accepted as true and construed in the light most favorable to the plaintiff. Id. However, because federal courts are courts of limited jurisdiction, the plaintiff bears the burden of establishing jurisdiction. Id.

III.

The FCA, 31 U.S.C. §§ 3729-3733, has a qui tam provision that allows a private individual to bring a civil action for violation of § 3729. See 31 U.S.C. § 3730(b)(1) (1994). The individual brings the action as a “relator”3 in a qui tam suit, acting on behalf of [330] the United States government. The government may recover treble damages from anyone who has committed a fraud upon the government, and the individual who brings the action may receive up to thirty percent of the money recovered. 31 U.S.C. § 3730(d)(2) (1994). The history of the FCA was set forth in this Circuit’s recent opinion in the McKenzie case:

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United States of America, Ex Rel. Maxine Jones v. Horizon Healthcare Corporation, 160 F.3d 326, 1998 WL 774104 (6th Cir. 1999).

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