U.S. Ex Rel. Jane Doe v. Heart Solution, PC

918 F.3d 300
CourtCourt of Appeals for the Third Circuit
DecidedMarch 14, 2019
Docket17-2019
StatusPublished
Cited by1 cases

This text of 918 F.3d 300 (U.S. Ex Rel. Jane Doe v. Heart Solution, PC) 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
U.S. Ex Rel. Jane Doe v. Heart Solution, PC, 918 F.3d 300 (3d Cir. 2019).

Opinion

ROTH , Circuit Judge .

Nita K. Patel and her husband, Kirtish N. Patel, were convicted of defrauding Medicare in a prior criminal proceeding. The United States then brought this civil action for the same fraudulent schemes against Ms. Patel, Ms. Patel's healthcare company (Heart Solution P.C.), Mr. Patel, and Mr. Patel's healthcare company (Biosound Medical Services). The United States prevailed in the District Court and only Ms. Patel and Heart Solution appealed.

In granting summary judgment to the United States, the District Court relied on the Patels' convictions and plea colloquies in the criminal case, essentially concluding that Ms. Patel had already admitted to all elements and issues relevant to her civil liability. However, the District Court failed to dissect the issues that were determined in the criminal case from those that were not. It lumped together Ms. Patel and Heart Solution, even though Heart Solution was not involved in the criminal case. It also failed to disaggregate claims Medicare paid to Ms. Patel and Heart Solution from those paid to Mr. Patel and Biosound. As such, it erred in finding that Ms. Patel and Heart Solution conceded all of the essential elements to every claim in this appeal. Thus, we will affirm the judgment of the District Court in part and vacate in part and remand for further proceedings consistent with this opinion.

I.

In November 2015, the Patels pled guilty to separate, but nearly identical, criminal information charges under 18 U.S.C. § 1347 for defrauding Medicare. 1 They conducted this fraud through two separate schemes. First, the Patels submitted diagnostic reports to Medicare that should have been written by a specialist physician-but were not-and contained forged physician signatures. Ms. Patel and Heart Solution do not dispute liability with respect to the claims involving this scheme. The second scheme involved diagnostic neurological testing. Medicare regulations require all diagnostic testing to be "reasonable and necessary," as defined under Medicare Part B. 2 In order for diagnostic neurological testing to be "reasonable and necessary," it must be performed under the proper level of physician supervision. 3 The Patels did not comply with these regulations. Instead of employing a supervising neurologist for these tests, the Patels falsely represented to Medicare that the neurological testing was being supervised by a licensed neurologist.

Much of this appeal centers on Ms. Patel's plea colloquy for her criminal conviction. The relevant parts of the colloquy follow. First, the sentencing judge asked Ms. Patel whether she and her husband "own and operate mobile diagnostic companies known as Biosound Medical Services and Heart Solution PC," and she responded, "yes." 4 Neither the court, the government, nor Ms. Patel clarified whether she had ownership interests in both *304 companies or just Heart Solution. 5 Next, the judge asked whether between 2006 and 2014, Ms. Patel and her husband "falsely represent[ed] to Medicare that the neurological testing being performed at Biosound Medical Services was being supervised by a licensed neurologist, when, in fact, it was not." 6 Again, she responded "yes." 7 Neither the court nor the parties addressed whether Heart Solution-as opposed to the Patels or Biosound-made any such misrepresentations. Finally, the judge asked whether, "Biosound Medical Services and Heart Solution, PC, [were] paid at least [$1.18 million] by Medicare. . . for diagnostic neurological testing that was never supervised by a licensed neurologist." Ms. Patel answered, "yes." 8 Neither the parties nor the court sought to clarify whether one company was paid the entire amount or whether the payments were divided between the companies.

In June 2014, relator Jane Doe brought a qui tam suit under the False Claims Act (FCA) against Ms. Patel, Mr. Patel, Biosound, and Heart Solution. The United States filed a complaint in intervention on November 18, 2015. The plaintiffs sought to hold the Patels and the two companies civilly liable for defrauding Medicare through the two schemes described above. Specifically, they claimed the defendants violated two provisions of the FCA by (1) "knowingly present[ing] or caus[ing] to be presented a false or fraudulent claim," 9 and (2) "knowingly mak[ing], us[ing], or caus[ing] to be made or used a false record or statement material to a false or fraudulent claim." 10 They also brought common law claims including fraud, unjust enrichment, disgorgement of profits, and payment by mistake of fact.

In March 2016, the plaintiffs moved for partial summary judgment on the two FCA counts, arguing that Ms. Patel's admissions during her plea colloquy established all the elements of the FCA claims and that therefore Heart Solution and Ms. Patel were collaterally estopped from contesting FCA liability. In their opposition brief, the defendants relied on a statement submitted by Mr. Patel in a pleading entitled "Certification of Kirtish N. Patel." In it, Mr. Patel claimed that Biosound employed a supervising neurologist from 2006 to 2007 and from 2012 to 2014. The defendants argued that the statement raised an issue of fact as to the time frame during which Biosound lacked a supervising neurologist. The statement was not sworn and was not made under the penalty of perjury.

The District Court granted summary judgment to plaintiffs on July 8, 2016, finding that the guilty pleas and accompanying colloquies established all elements of the FCA claims and collaterally estopped the defendants from contesting liability. It also struck the section of Mr. Patel's statement regarding the time frame during which Biosound had a supervising neurologist because it was "self-serving" and conflicted with testimony from the plea colloquy regarding the time frame without any *305 "reasonable explanation." On December 23, 2016, the government moved for summary judgment on the remaining common law claims under the same theory-that the defendants had admitted to all the elements of the claims. The District Court agreed and granted the motion on April 3, 2017.

On May 3, 2017, Ms. Patel and Heart Solution appealed both summary judgment orders. 11 They submit two primary arguments. First, they contend that Ms. Patel cannot be liable for any unsupervised neurological testing at Biosound because she did not own or operate Biosound, and thus had no legal duty to ensure Biosound employed a neurological testing supervisor.

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Cite This Page — Counsel Stack

Bluebook (online)
918 F.3d 300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/us-ex-rel-jane-doe-v-heart-solution-pc-ca3-2019.