Wake Forest Law Review
16Mar

Fourth Circuit Considers Scope of FCA’s First-to-File Rule

Categories: 4th Cir. Blog Archive Civil Cases
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By Mickey Herman

On Thursday, March 16, 2017, the Fourth Circuit issued a published opinion in United States ex rel. Carson v. Manor Care, Inc., a civil case. Plaintiff-appellant, Patrick Carson, on behalf of the United States, appealed the dismissal of his False Claims Act (“FCA” or “Act”) qui tam and retaliation claims as well as related state fraud claims, arguing that none were barred by the FCA’s first-to-file rule. After evaluating Carson’s claims in turn, the Fourth Circuit affirmed with respect to his qui tam claims, but vacated and remanded the portion of the trial court’s decision as it related to his retaliation and state fraud claims.

Facts & Procedural History

In early 2009, Christine Ribik filed a qui tam suit on behalf of the United States against Manor Care, alleging violations of the FCA arising from overbilling of the government for medical services. Specifically, she contended that the nursing facility operator “regularly and fraudulently classified . . . patients as needing more physical therapy than necessary,” “instructed its physical therapists to spend more time than needed with the patients,” “sent some patients to physical or occupational therapy who did not need it at all,” and “refused to discharge patients for whom physical therapy was no longer useful.”

In September 2011, Carson filed a qui tam suit on behalf of the United States and several states against Manor Care, alleging violations of the FCA (and its state-level equivalents) markedly similar to those asserted by Ribik. In addition, Carson asserted a FCA retaliation claim, contending that his termination from Manor Care was a direct and impermissible result of “his repeated complaints about the fraudulent . . . practices.”

The two cases were consolidated in 2012 and the United States Government subsequently intervened in the action. The district court denied Manor Care’s motion to dismiss the Government’s complaint. It granted, however, the defendant’s motion to dismiss Carson’s complaint, concluding that “the FCA’s first-to-file rule barred all of [his] claims.” Carson appealed.

Qui Tam Claims

The Court first considered whether the first-to-file rule barred Carson’s qui tam claims. Pursuant to its qui tam provision, the FCA permits private citizens to sue on the federal government’s behalf for violations of the Act. However, “[w]hen a person brings an action under [the qui tam] subsection, no person other than the Government may intervene or bring a related action based on the facts underlying the pending action.” To determine whether a subsequently-filed suit is based on the facts underlying a pending complaint, the Court applies the “material elements test,” which “bars later suit ‘if it is based upon the same material elements of fraud as the earlier suit, even though the subsequent suit may incorporate somewhat different details.’” Although Carson argued that his “allegations go well beyond [Ribik’s],” the Court, after thoroughly comparing the complaints’ allegations, disagreed. It also rejected Carson’s assertion that their complaints’ consolidation protects his claims from the first-to-file bar, emphasizing that the relevant statutory language explicitly prohibits intervenors other than the Government. It thus affirmed the district court’s dismissal of Carson’s qui tam claims.

Retaliation Claim

The Court turned next to Carson’s retaliation claim. “The FCA prohibits employers from retaliating against any employee ‘because of lawful acts done by the employee . . . in furtherance of an action under this section or other efforts to stop 1 or more violations of this subchapter.’” Noting that the district court dismissed this claim on the same grounds as the qui tam claims—the first-to-file rule—the Court endeavored to determine whether retaliation claims fall within the scope of that rule. Considering first the relevant statutory language and structure, the Court emphasized that the first-to-file rule is subsumed by, and therefore only limits, the Act’s qui tam provisions. The Court continued by emphasizing that barring a whistle-blower’s retaliation claim on such grounds makes little sense, both because such claims are considered personal to the plaintiff (unlike the qui tam claims, which effectively belong to the Government) and due to the risk of deterring whistle-blowers. For these reasons, the Court vacated the district court’s dismissal as to Carson’s retaliation claim and remanded the issue for proceedings consistent with the proper scope of the first-to-file rule.

State Fraud Claims

Finally, the Court considered whether the FCA’s first-to-file rule was properly applied to Carson’s state fraud claims. Determining that the district court failed to “support its decision with any discussion or authority to establish that any of the states apply the FCA first-to-file rule, or its equivalent, to that state’s statute,” the Court vacated and remanded the issue to the district court.

Conclusion

Agreeing that the FCA’s first-to-file rule barred Carson’s qui tam claims, the Court affirmed the district court to that extent. It refused, however, to extend the scope of the first-to-file rule to Carson’s retaliation and state fraud claims. It therefore vacated the district court’s judgment as to those issues, and remanded for further proceedings.

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18Nov

Fourth Circuit Affirms Coal Company’s Liability in Employment Benefits Case

Categories: 4th Cir. Blog Civil Cases
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By: Kristina Wilson

On Friday, November 18, 2016, the Fourth Circuit issued a published opinion in the civil case RB&F Coal, Inc. v. Mullins. The Fourth Circuit affirmed the U.S. Department of Labor’s Benefits Review Board’s finding that a coal miner, Turl Mullins, and his wife, Deloris Mullins, were entitled to employment and survivors’ benefits under 30 USC § 901 et seq (Black Lung Benefits Act). While the parties agreed that the Mullinses should be compensated, on appeal, the parties disputed whether RB&F Coal, Inc. should be responsible for paying the benefits.

The Statutory Scheme

The Fourth Circuit’s analysis was governed by the Black Lung Benefits Act (“BLBA”) and Virginia’s Guaranty Act. Under the BLBA, a mine operator that employs a miner who becomes disabled by pneumoconiosis is responsible for compensating the miner. 30 USC §§ 901(a), 922(a), 932(b), 932(c). Where multiple coal companies employ a miner, the most recent company to employ the miner is liable for the payments, as long as the company qualifies as a “potentially liable operator.” 20 C.F.R. § 725.495(a)(1). To be a “potentially liable operator,” the coal company and/or its insurer must be financially capable of assuming liability. Id. § 725.494(e).

Virginia’s legislature established the Virginia Property and Casualty Insurance Guaranty Association (VPCIGA), a state chartered non-profit association that provides payment of “covered claims” resulting from insolvent insurers. Va. Code Ann. § 38.2-1603. Virginia state laws require all insurance companies conducting business in Virginia to join the VPCIGA. Id. §§ 38.2-1604. The VPCIGA is only responsible for the claims of an insolvent insurer that are “covered claims,” as defined in the Guaranty Act. Id. § 38.2-1606(A)(1). “Covered claims” include “. . . any claim filed with the VPCIGA after the final date set by the court for the filing of claims against the liquidator or receiver of an insolvent insurer.” Id. § 38.2-1606(A)(1)(b).

Facts and Procedural History

Between 1985 and 1988, Turl Mullins worked for several different coal companies, including RB&F Coal, Inc. (“RB&F”) and Wilder Coal (“Wilder”). Mullins developed pneumoconiosis in 2009 and filed a Black Lung Benefits Act (“BLBA”) claim in that same year. At the time of filing, Mullins’s most recent employer, Wilder, was out of business and its insurer declared insolvent. Therefore, the Department of Labor district director imposed liability on RB&F for payments to the Mullinses. RB&F challenged the finding and transferred the case to an Administrative Law Judge.

The Administrative Law Judge affirmed the Department of Labor’s finding because RB&F failed to prove that Wilder Coal was capable of financially assuming the liability. RB&F appealed the Administrative Law Judge’s finding with the Department of Labor’s Benefits Review Board, but the Benefits Review Board affirmed. This appeal followed.

Wilder Is Not a “Responsible Operator” under the BLBA

On appeal, RB&F first argued that Wilder qualified as a “responsible operator” because Wilder’s claims are still “otherwise guaranteed,” under Virginia’s Guaranty Act. However, Virginia’s Guaranty Act excluded claims filed after the final date set by a court for claims against an insolvent insurer. Va. Code Ann. § 38.2-1606(A)(1)(b). The final date set by a court for claims against Wilder’s insurer was August 26, 1992. Mullins did not file his claim until 2009. Therefore, Mullins’ claim was not “otherwise guaranteed.”

The BLBA Does Not Preempt the Guaranty Act

RB&F next argued that the BLBA preempted the Guaranty Act’s limitation of liability for black lung claims. In so arguing, RB&F assumed that the VPCIGA was an insurer under the BLBA. The Department of Labor regulations implementing the BLBA provide that an insurer is any fund, including a State fund, that is authorized under a state’s workers’ compensation laws to insure employers’ liability. 20 C.F.R. § 725.101(a)(18). However, Virginia’s workers’ compensation laws prevented the VPCIGA from covering Wilder’s insurer’s claims past a certain date. In fact, the Guaranty Act precluded the VPCIGA from providing full coverage of all the claims of an insolvent insurer. Thus, the VPCIGA is not an insurer under the BLBA, and as such, the BLBA does not preempt the Guaranty Act.

Disposition

Therefore, because RB&F established neither that Wilder was a “responsible operator” nor that the BLBA preempted the Guaranty Act, the Fourth Circuit affirmed the Benefits Review Board’s imposition of liability on RB&F.

 

 

 

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9Nov

Fourth Circuit Rules Virginia’s Geriatric Release Program Violates Eighth Amendment Rights of Juveniles Serving Life Sentences for Non-Homicide Offenses

Categories: Civil Cases
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By John Van Swearingen

On Wednesday, November 9, 2016, the Fourth Circuit issued a published opinion in the civil case LeBlanc v. Mathena. This matter was a habeas corpus petition brought by a juvenile offender sentenced to life without parole for a non-homicide offense. The District Court of the Eastern District of Virginia had previously concluded that Virginia’s Geriatric Release program, which provides offenders sentenced to life without parole the opportunity to petition for conditional release after the age of sixty, violated the minimum standards of the incorporated Eighth Amendment as held in Graham v. Florida, 560 U.S. 48 (2010). In Graham, the Supreme Court of the United States held that the Eighth Amendment forbids the sentencing of juveniles convicted of non-homicide offenses to life without parole. Juvenile life sentences for non-homicide offenses must provide a meaningful and realistic opportunity to obtain release based on “demonstrated maturity and rehabilitation.” Here, the circuit court affirmed the district court’s ruling, holding that Geriatric Release does not meet the requirements of Graham.

Facts and Procedural History

On January 1, 1995, Virginia enacted Va. Code Ann. § 53.1-165.1 (2015), abolishing parole for felonies convicted after that date. On July 6, 1999, the Petitioner committed the crimes of rape and abduction, and on July 15, 2002, he was convicted and sentenced to two life sentences.

After the Supreme Court decided Graham in 2010, the Petitioner filed a motion in Virginia state court to vacate his sentence of life without parole. In 2011, the state trial court denied Petitioner’s motion based on Angel v. Commonwealth, a contemporaneous Virginia Supreme Court decision holding that Virginia’s Geriatric Release program satisfied the requirements of Graham.

In June of 2012, the Petitioner filed a writ of habeas corpus in the District Court of the Eastern District of Virginia. The district court granted the habeas petition, holding that the Geriatric Release program did not meet the standards established in Graham. The Respondents in this case, the state, timely filed this appeal.

Virginia’s Geriatric Release Program

Virginia’s Geriatric Release program is a two-stage process by which convicted offenders with life sentences can apply for conditional release. Unlike Virginia’s abolished parole doctrine, the Geriatric Release program is not automatic. Offenders must initiate the process with a petition to the Parole Board – and again, they may only do so after their sixtieth birthday.

The first stage of the Geriatric Release process requires the offender’s petition demonstrate a “compelling” reason for the release of the offender. The term “compelling” is not defined in the relevant statute or administrative regulations. The Parole Board is able to deny the petition for Geriatric Release for any reason at this point.

Should the Parole Board permit the petition to go to the second stage, the offender will be provided the opportunity to make oral and written statements to the Parole Board to advocate for his or her release. If at least four out of five members of the Board agree, the offender’s petition for Geriatric Release will be granted.

Again, the process is distinguishable from the old parole system. Geriatric Release cannot be initiated until the offender turns sixty. Virginia’s parole process typically initiated after offenders had served about fifteen years. The Petitioner would likely have been eligible for parole, under the old system, after around twenty years. Under the Geriatric Release program, that length of time is approximately doubled. Further, only three out of five members of the Parole Board had to agree to grant parole. The Geriatric Release program requires one more member of the board for approval.

Standard of Review for Habeas Corpus Petitions

When a habeas petition is filed, the standard of review turns on whether the petition involves a question of law or fact. This case presents a question of law, meaning the standard of review is stated at 28 U.S.C. § 2254(d)(2) (2012). If the court’s decision was an “unreasonable determination” of how the law applies to the facts in this case, then the court’s decision was improper. If the decision was reasonable, it stands.

Habeas petitions in federal district courts must review the case at hand in addition to the most recent state case addressing the issue. In this case, the most recent state case was the Angel decision, which held that the Geriatric Release program met the requirements of Graham. Since the state decision is contrary to the district court’s decision, either Angel or the district court’s decision will be determined unreasonable, and one holding will be affirmed.

The Standard Established in Graham

The holding in Graham was based on the Supreme Court’s conclusion that juveniles are less culpable for crimes than adults. Juvenile brains, the Court noted, are still developing. Because of this, the Court stated, juvenile offenders are less likely to be “irretrievably depraved” than adults. With that in mind, the Court examined the prospect of life without parole for juveniles convicted of non-homicide offenses in the context of the Eighth Amendment.

The Court noted that life without parole is only second to the death penalty in its harshness and ability to deprive convicted persons of hope. Life without parole is, therefore, an ultimate judgment of the irrevocable nature of an offender’s character. Given those points, the Court held that life sentences for juveniles convicted of non-homicide offenses must meet three requirements.

First, the sentence must provide an opportunity to obtain release based on “demonstrated maturity and rehabilitation.” Second, this opportunity must be meaningful and realistic. Third, the state’s parole and release programs at large must account for the lesser culpability of juveniles.

The Geriatric Release Program Does Not Satisfy the Graham Requirements

The Fourth Circuit held that the Virginia Geriatric Release program does not meet any of the three requirements set out in the Graham decision, thus overturning Angel and affirming the district court’s holding.

First, the Geriatric Release program does not require the Parole Board to consider any factors relevant to the juvenile’s maturity or rehabilitation. Additionally, because of the two-stage review process, a petition can be denied at the first stage – before the presentation of oral and written arguments. Also, over 95% of the denials of Geriatric Release petitions were based on the nature of the underlying crimes, which, again, precludes consideration of maturity and rehabilitation. Therefore, the program does not meet the first requirement of Graham.

Second, the circuit court held the extended duration of time compared to parole, coupled with the lack of consideration for juvenile-specific factors, rendered the opportunity provided under the Geriatric Release program neither meaningful nor realistic for juvenile offenders facing life sentences. Therefore, the program does not meet the second requirement of Graham.

Finally, the Geriatric Release program fundamentally contravenes the concerns underlying the Court’s third requirement in Graham. Unlike the abolished parole program, which counted time served regardless of age, the Geriatric Release program requires juveniles serving life sentences to spend a longer percentage of their life incarcerated than an adult serving the same sentence. Essentially, the program ensures that juveniles, though deemed to be less culpable by the Supreme Court, will bear a harsher punishment than adults.

Disposition

The Fourth Circuit affirmed the district court’s order remanding the Petitioner’s case for resentencing. The Virginia Geriatric Release program permits the denial of offender’s petitions without requiring consideration of demonstrated maturity or rehabilitation. The program, in execution, results in more comparably harsh sentences for juvenile offenders than adult offenders. Therefore, the Geriatric Release program does not meet the requirements of the incorporated Eighth Amendment as enumerated in Graham.

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