U.S. ex rel. Matt Anderson v. St. Elizabeth Med. Ctr.

Court of Appeals for the Sixth Circuit·Decided April 17, 2026·No. 25-5858·Unpublished

Opinion

NOT RECOMMENDED FOR PUBLICATION File Name: 26a0174n.06

Case No. 25-5858

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT

FILED

Apr 17, 2026

) KELLY L. STEPHENS, Clerk UNITED STATES OF AMERICA and )

COMMONWEALTH OF KENTUCKY ex rel., )

MATT ANDERSON.

) ON APPEAL FROM THE

) UNITED STATES DISTRICT UNITED STATES OF AMERICA, ) COURT FOR THE EASTERN Intervenor-Plaintiff, ) DISTRICT OF KENTUCKY )

MATT ANDERSON, )

) OPINION Relator-Appellant, )

)

v. )

)

SAINT ELIZABETH MEDICAL CENTER, INC.; ) SUMMIT MEDICAL GROUP, INC., dba St. ) Elizabeth Physicians, )

Defendants-Appellees. )

Before: CLAY, McKEAGUE, and NALBANDIAN, Circuit Judges.

NALBANDIAN, Circuit Judge. Matt Anderson believes that St. Elizabeth Medical Center, Inc., and Summit Medical Group, Inc. (together, St. Elizabeth) hoodwinked state and federal public healthcare programs by charging them for medically unnecessary kidney and vascular procedures and receiving kickbacks. So Anderson sued St. Elizabeth under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq., and Kentucky’s negligence per se statute, Ky. Rev. Stat. § 446.070. The district court granted St. Elizabeth’s motion for judgment on the pleadings, reasoning that Anderson’s FCA claim is barred because his allegations were already in the public domain and that the Kentucky law claim fails as a matter of law. We largely agree, and to the

extent we don’t, we find that Anderson’s claims fail for independent reasons supported by the record. So we affirm.

I.

This is a case about doctors allegedly defrauding the government. More specifically, it’s about the standards by which the law decides whether a whistleblower can sue on such allegations in the government’s place.

We’ve got three questions to answer on that front. How much fresh information does the FCA—the federal statute empowering private individuals to bring such claims on behalf of the government—require before assigning the whistleblower the right to sue? How specific must the whistleblower’s factual allegations of fraud be to pass muster under the Federal Rules of Civil Procedure? And does Kentucky law offer a device of its own to empower private plaintiffs to initiate civil suits on the government’s behalf?

To answer those questions, we start by recounting the story that prompted us to ask them in the first place. That tale began more than seven years before this lawsuit, in a since-dismissed case called United States ex rel. Kent v. St. Elizabeth Medical Center (Kent), 2:17-cv-3 (E.D. Ky. Jan. 11, 2017). So we’ll begin there, then move to the facts and procedural history underlying this appeal.

A.

More than seven years before this lawsuit, James Kent (not a party here, but represented by attorneys affiliated with Anderson’s counsel) filed an FCA action against St. Elizabeth, among others. Both Kent’s and Anderson’s versions center on allegations that St. Elizabeth fraudulently billed the public fisc for unnecessary medical services. And because the former provides nearly

all the factual material underlying the latter—and because, as we explain later, that’s nearly dispositive of this case—we start with it.

The Kent complaint alleged a conspiracy to pay physicians to refer patients for medically unnecessary kidney dialysis treatments starting in 2014. Two entities allegedly hatched the plot: The Kidney and Hypertension Center, Inc. (KHC) and Davita Healthcare Partners Inc. (Davita). Davita operated six dialysis centers in Northern Kentucky under a shared-ownership arrangement with KHC. Davita retained a 51% majority interest, and KHC held the remaining equity. And because KHC’s physicians “were stationed at St. Elizabeth’s facilities, [the KHC physicians] caused the maximum number of patients at St. Elizabeth . . . to be referred to the [jointly-owned] dialysis center” located nearest to the St. Elizabeth facility. R.18-2, Kent Compl., PageID 125. In exchange for those automatic referrals, KHC’s physicians received kickbacks to the tune of $70,000 per dialysis center per year.

Eventually, according to the Kent complaint, the KHC-Davita scheme expanded to include St. Elizabeth itself. KHC cut St. Elizabeth in by transferring part of its ownership interest in the dialysis centers to St. Elizabeth in exchange for St. Elizabeth automatically referring “all patients who even remotely present for kidney care” to KHC, which would in turn send the patients along for dialysis “even though the patients clearly do not medically need kidney dialysis.” Id. at PageID 126.

In other words, St. Elizabeth and KHC worked together to gin up as many dialysis patients as possible for Davita. In exchange, they received substantial kickbacks. And unsurprisingly, that structure incentivized St. Elizabeth and KHC to refer as many patients to Davita as possible, even if dialysis was medically unnecessary.

To pay St. Elizabeth and KHC, Davita submitted claims for reimbursement to Medicare, Medicaid, and other government health care programs. Here’s the rub: the statutes and regulations governing Medicare and Medicaid specify that they pay for only medically necessary services. And separately, the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), makes it unlawful to offer or receive any “remuneration” in exchange for medical referrals that can be billed to a federal healthcare program like Medicare or Medicaid.

So because Kent believed that St. Elizabeth, KHC, and Davita violated (1) the Medicare and Medicaid statutes and regulations by billing the public fisc for unnecessary procedures and (2) the Anti-Kickback Statute by offering and receiving kickbacks for dialysis treatment, he sued all three players under the FCA, which empowers private civil plaintiffs to sue entities who defraud the government and share in the recovery. 31 U.S.C. § 3729; see United States ex rel. Rahimi v. Rite Aid Corp., 3 F.4th 813, 822 (6th Cir. 2021). He also brought a claim under Ky. Rev. Stat. § 205.8463, a criminal statute that doesn’t explicitly include a private cause of action like the FCA. Ultimately, though, Kent—himself a dialysis patient—passed away, and the administrator of his estate voluntarily dismissed the lawsuit. The Government did not intervene in the matter.

B.

Seven years after Kent, Matt Anderson came along telling largely the same story. To avoid repetition, we’ll focus our description on those of Anderson’s allegations that add to Kent.

Anderson’s first addition1 to the Kent allegations concerned the dialysis scheme itself. To start, he identified the leader of KHC as a physician named Dr. Shaughnessy. He also alleged that

1 To be clear, Anderson concedes only that his allegations are “loosely similar” to Kent’s. Reply Br., p.1. He emphasizes that his allegations spell out “something materially different in time and operational detail,” constituting a “later-developing architecture” of a new fraud scheme. Id. at p.3. But as we discuss later, the allegations at the core of Anderson’s case are essentially identical

St. Elizabeth, to push its induction into the Davita-KHC scheme, “hired new nephrologists of their own”—ostensibly referring to non-KHC kidney doctors who work directly for St. Elizabeth—“and began to play ‘hard ball’” with KHC (what he means by that, he doesn’t say). R.1, Compl., PageID 7. And finally, Anderson added allegations about the nuts and bolts of the scheme. He described how St. Elizabeth mandates the flow of patients from its primary care physicians to the dialysis scheme through the “EPIC system,” a medical referral software set up such that physicians can realistically refer only to specialists who are in on the take. Id. at PageID 9–10.

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U.S. ex rel. Matt Anderson v. St. Elizabeth Med. Ctr., (6th Cir. 2026).

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