United States of America, Ex Rel. Stinson, Lyons, Gerlin & Bustamante, P.A. v. The Prudential Insurance Company

944 F.2d 1149, 1991 WL 181404
CourtCourt of Appeals for the Third Circuit
DecidedOctober 10, 1991
Docket90-5445
StatusPublished
Cited by217 cases

This text of 944 F.2d 1149 (United States of America, Ex Rel. Stinson, Lyons, Gerlin & Bustamante, P.A. v. The Prudential Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States of America, Ex Rel. Stinson, Lyons, Gerlin & Bustamante, P.A. v. The Prudential Insurance Company, 944 F.2d 1149, 1991 WL 181404 (3d Cir. 1991).

Opinions

OPINION OF THE COURT

SLOVITER, Chief Judge.

This appeal from the district court’s dismissal of a complaint for lack of subject matter jurisdiction requires us to interpret the jurisdictional bar provisions of the False Claims Act, 31 U.S.C. §§ 3729-3733 (1988) (FCA). The law firm of Stinson, [1151]*1151Lyons, Gerlin & Bustamante, P.A. (Stinson) filed this action on behalf of the United States against Prudential Insurance Company alleging that Prudential defrauded the Government by avoiding its statutory responsibility to pay certain insurance claims as the primary insurer. The district court dismissed the complaint on the ground that it lacked subject matter jurisdiction because the action was based solely on information or allegations that had been publicly disclosed in previous litigation. We have jurisdiction over Stinson’s timely appeal under 28 U.S.C. § 1291 (1988).

I.

Facts and Procedural History

Stinson learned of Prudential’s allegedly fraudulent activity during its representation of T. Armlon Leonard in 1983 in connection with injuries sustained by Leonard in an automobile accident. Leonard, who was 67 years old at the time of the accident, was covered by a group insurance plan provided by his employer and carried by Provident Life and Accident Insurance Company (Provident).

In the course of processing Leonard’s claim against Provident, Stinson formed a suspicion that Provident’s claim processing practice was in violation of federal law, specifically the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), Pub.L. No. 97-248, § 116(b), 96 Stat. 324, 353 (1982), in which Congress shifted primary liability for benefit claims of people covered both by Medicare and employer group health plans (working seniors) from Medicare to the private group plan. Stinson believed that, notwithstanding TEFRA, Provident was avoiding its responsibility by allowing Medicare to continue to pay as the primary insurer the benefit claims of Arm-lon and other working seniors.

Provident filed suit against Leonard in the Circuit Court for Dade County, Florida, seeking a declaratory judgment establishing the legality of its claim procedure. Provident Life & Accident Ins. Co. v. Leonard, No. 85-10113 CA(15) (Fla. Dade County Cir.Ct.) (the “Leonard litigation”). Through discovery in the Leonard litigation, Stinson obtained two internal Provident memoranda, admittedly hearsay, which Stinson reads as suggesting that other insurance companies had similar claim processing practices.

The first document contained the results of a Provident telephone survey of the claim processing practices of other insurance companies with respect to working seniors. Next to the name “Arthur M. Wood, Vice President, Prudential Insurance Company” appears the handwritten notation, “Left message — Same as us.” App. at 81. The notation is unsigned, and there is no indication who asked the question or who prepared the document. The second document, a Provident memorandum entitled “Policy Issue Medicare Reimbursement” which recommended that Provident change its claim processing procedure, repeated the same notation, “Prudential — Same as us,” under the heading “Input,” apparently on the basis of the earlier memorandum. App. 400. According to Stinson’s affidavit, it filed these memoran-da with the Florida court on October 6, 1986, eleven days after obtaining them from Provident.

In early 1988, a year and a half later, Stinson brought an action on behalf of the United States against Provident under the qui tam provisions of the False Claims Act (FCA). See United States ex rel. Stinson, et al. v. Provident Life & Accident Ins. Co., 721 F.Supp. 1247 (S.D.Fla.1989). Thereafter, Stinson filed identical actions against Prudential and the other insurance companies allegedly implicated by the Provident memoranda. See United States ex rel. Stinson et al. v. Provident Life & Accident Ins. Co., CIV 1-89-331 (E.D.Tenn.); United States ex rel. Stinson et al. v. Blue Cross Blue Shield of Ga., Inc., 755 F.Supp. 1040 (S.D.Ga.1990); United States ex rel. Stinson et al. v. Pilot Life Ins. Co., C-90-29-G (M.D.N.C.); United States ex rel. Stinson et al. v. Pan American Life Ins. Co., No. 90-411 (E.D.La.). In each case, Stinson argued that the insurance company defrauded the government by allowing Medicare to pay as primary insurer for claims of working seniors.

[1152]*1152As required by the FCA, 31 U.S.C. § 3730(b)(2), Stinson disclosed the information on which the claim against Prudential was based to the United States. The Government declined to intervene, and Stin-son proceeded with the action. Prudential moved for dismissal under Rule 12(b)(1) asserting that the law firm did not qualify as a proper qui tam plaintiff.1

The district court dismissed the complaint, finding that it did not have subject matter jurisdiction. United States ex rel. Stinson, et al. v. Prudential Ins. Co., 736 F.Supp. 614 (D.N.J.1990). The district court relied on the FCA’s jurisdictional bar contained in 31 U.S.C. § 3730(e)(4)(A), which precludes suits based on, inter alia, the “public disclosure” of allegations or transactions in a civil “hearing,” unless the qui tam plaintiff is an “original source” of the information.

The district court held that Stinson’s qui tam action was based solely on the Provident memoranda which had been publicly disclosed for purposes of the jurisdictional bar of the FCA when they were obtained by Stinson through civil discovery. Stinson, 736 F.Supp. at 618-19, 622. The court held that Stinson was not an “original source” because its suit was based exclusively on the information contained in the Provident memoranda, and thus its knowledge of Prudential’s allegedly fraudulent practice was neither direct nor independent of the public disclosure. Id. at 622-23. We have plenary review of the district court’s dismissal of the complaint for lack of subject matter jurisdiction. See York Bank & Trust Co. v. Federal Sav. and Loan Ins. Corp., 851 F.2d 637, 638 (3d Cir.1988), cert. denied, 488 U.S. 1005, 109 S.Ct. 785, 102 L.Ed.2d 777 (1989).

II.

The False Claims Act and Its History

A.

The Act

The FCA provides penalties for persons who knowingly submit fraudulent claims to the Government. Civil actions may be brought by the Government or, in certain circumstances, by a private plaintiff (qui tam plaintiff)2 on behalf of the Government. Before proceeding with the suit, the qui tam plaintiff must disclose the information on which the claim is based to the Government, and the Government has sixty days to intervene. 31 U.S.C. § 3730(b). If the Government does not intervene, the qui tam

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Bluebook (online)
944 F.2d 1149, 1991 WL 181404, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-of-america-ex-rel-stinson-lyons-gerlin-bustamante-pa-ca3-1991.