U.S. ex rel. Saldivar v. Fresenius Medical Care Holdings, Inc.

906 F. Supp. 2d 1264, 2012 WL 5866189, 2012 U.S. Dist. LEXIS 97625
CourtDistrict Court, N.D. Georgia
DecidedMarch 26, 2012
DocketCivil Action No. 1:10-CV-01614-AT
StatusPublished
Cited by9 cases

This text of 906 F. Supp. 2d 1264 (U.S. ex rel. Saldivar v. Fresenius Medical Care Holdings, Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. Georgia 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. Saldivar v. Fresenius Medical Care Holdings, Inc., 906 F. Supp. 2d 1264, 2012 WL 5866189, 2012 U.S. Dist. LEXIS 97625 (N.D. Ga. 2012).

Opinion

ORDER

AMY TOTENBERG, District Judge.

This matter is before the Court on Defendant Fresenius Medical Care Holdings, Inc.’s (“Fresenius”) motion to dismiss Relator Chester Saldivar’s Amended Complaint. [Doc. 42.] Relator has alleged that Defendant has engaged in a fraudulent billing scheme involving medications it received for free from manufacturers and administered to dialysis patients but sought reimbursement from various governmental agencies in violation of the False Claims Act and numerous state-law equivalents. For the reasons set forth below, the Court GRANTS IN PART and DENIES IN PART Defendant Fresenius’ motion to dismiss Relator’s Amended Complaint.

[1268]*1268I. STANDARD FOR MOTION TO DISMISS

Although Defendant seeks dismissal under Federal Rule of Civil Procedure 12(b)(6), courts have generally observed that the public disclosure bar is jurisdictional and, therefore, more properly addressed under Federal Rule of Civil Procedure 12(b)(1). See, e.g., Rockwell Int’l Corp. v. U.S., 549 U.S. 457, 467-68, 127 S.Ct. 1397, 167 L.Ed.2d 190 (2007) (holding that § 3730(e)(4) of the False Claims Act is jurisdictional); Battle v. Bd. of Regents, 468 F.3d 755, 762 (11th Cir.2006). Defendant’s motion to dismiss asserts that Relator’s allegations have been publicly disclosed, “such that the Court lacks jurisdiction.” (Defs.’ Mot. Dismiss ¶ 4.) Defendant’s memorandum in support of its motion to dismiss also states explicitly that “[t]he public disclosure bar is jurisdictional.” (Defs.’ Mem. Supp. Mot. Dismiss at 2.)

The Eleventh Circuit has recognized that a motion to dismiss for lack of subject matter jurisdiction may be based on either a facial or factual challenge to the complaint. See McElmurray v. Consol. Gov’t of Augusta-Richmond County, 501 F.3d 1244, 1251 (11th Cir.2007). “A ‘facial attack’ on the complaint ‘require[s] the court merely to look and see if [the] plaintiff has sufficiently alleged a basis of subject matter jurisdiction, and the allegations in his complaint are taken as true for the purposes of the motion.’ ” Id. (quoting Lawrence v. Dunbar, 919 F.2d 1525, 1529 (11th Cir.1990)). In this sense, a facial challenge equips a plaintiff with safeguards similar to those afforded by a Rule 12(b)(6) motion for failure to state a claim and limits the court to a comparable scope of review. See id.

A factual attack, on the other hand, “challenged] ‘the existence of subject matter jurisdiction in fact, irrespective of the pleadings.’ ” Id. (quoting Lawrence, 919 F.2d at 1529). Accordingly, when addressing a factual attack, the Court may consider matters outside the pleadings, such as testimony and affidavits. Id. To compensate for this broader scope of review, the former Fifth Circuit established that in a factual challenge, the Court must give the plaintiff an opportunity for discovery and for an appropriate hearing. Williamson v. Tucker, 645 F.2d 404, 414 (5th Cir.1981), as recognized in McElmurray, 501 F.3d at 1251.

If the Court were to construe Defendant’s challenge on the basis of § 3730(e)(4) of the False Claims Act as a factual attack on this Court’s subject matter jurisdiction, it would, in essence, convert Defendant’s motion into one comparable to summary judgment. Even under the motion-to-dismiss standard, the Court’s consideration of documents extrinsic to the pleadings converts a Rule 12(b)(6) motion to dismiss to a Rule 56 motion for summary judgment. The Court will not convert Defendant’s Rule 12(b)(6) motion to dismiss into a motion for summary judgment sua sponte.1 Accord[1269]*1269ingly, and because Defendant’s motion was argued pursuant to Rule 12(b)(6), the Court reads Defendant’s motion to dismiss as a facial challenge.

This Court may dismiss a pleading for “failure to state a claim upon which relief can be granted.” Fed.R.Civ.P. 12(b)(6). A pleading fails to state a claim if it does not contain allegations that support recovery under any recognizable legal theory. 5 Charles Alan Wright & Arthur R. Miller, Federal Practice & Procedure § 1216 (3d ed. 2002); see also Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 1949, 173 L.Ed.2d 868 (2009). In considering a Rule 12(b)(6) motion, the court construes the pleading in the non-movant’s favor and accepts the allegations of facts therein as true. See Duke v. Cleland, 5 F.3d 1399, 1402 (11th Cir.1993). The pleader need not have provided “detailed factual allegations” to survive dismissal, but the “obligation to provide the ‘grounds’ of his ‘entitle[ment] to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). In essence, the pleading “must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Iqbal, 129 S.Ct. at 1949 (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955).

II. BACKGROUND

Relator is a resident of California, formerly employed by Defendant Fresenius from March 31, 2007, until December 18, 2009. (Compl. ¶ 10.) Fresenius is headquartered in Massachusetts and is the country’s largest dialysis services provider. (Id. at ¶¶2, 11.) As such, Fresenius is entitled to reimbursement from federal and state health care programs (e.g., Medicare and Medicaid) for costs associated with covered patient treatment. (Id. at ¶ 2.) In addition to composite payments for its routine dialysis treatment regime, Fresenius is entitled to separate reimbursement for certain injectable medications that it purchases and administers to dialysis patients. (Id. at ¶ 22.) At issue in this case are Fresenius’ billing practices for two such medications: Zemplar (a Vitamin D analog) and Epogen (a hormone used to lessen the effects of anemia). (Id. at ¶¶ 3, 18-19.) Relator contends that during and by virtue of his employment with Fresenius, he learned that Fresenius bills the government for doses of Zemplar and Epogen that it received for free, resulting in Fresenius submitting an estimated “hundreds of millions of dollars” in fraudulent reimbursement claims. (Id. at ¶¶ 4, 47, 87.)

Consistent with industry standards, manufacturers of Zemplar and Epogen include in each vial a surplus volume of each drug, referred to as “overfill.” (Id.

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906 F. Supp. 2d 1264, 2012 WL 5866189, 2012 U.S. Dist. LEXIS 97625, Counsel Stack Legal Research, https://law.counselstack.com/opinion/us-ex-rel-saldivar-v-fresenius-medical-care-holdings-inc-gand-2012.