U.S. ex rel. Quartararo v. Cath. Health Sys. of Long Island Inc., No. 21-1534 (2d Cir. 2023)
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Catholic Health System of Long Island (“CHS”) brings this interlocutory appeal challenging the denial of its motion to dismiss a qui tam action brought by a former employee (“Relator”) on behalf of the United States and the State of New York under the federal False Claims Act (“FCA”), and the New York False Claims Act (“NYFCA”). According to Relator, CHS and certain of its affiliates falsely certified their compliance with federal law, in violation of the FCA and NYFCA, when they submitted Medicare and Medicaid reimbursement claims without disclosing their ongoing violations of 42 U.S.C. Section 1320a-7b(a)(4) (the “Benefits Conversion Statute”). After the Department of Justice and the New York Attorney General declined to intervene in the suit, the district court denied CHS’s motion to dismiss these claims but granted its motion to certify an interlocutory appeal pursuant to 28 U.S.C. Section 1292(b) on the grounds that the case presented an issue of first impression.
The Second Circuit reversed. The court held that the Benefits Conversion Statute is not violated where, as here, the recipient of a reimbursement payment is under no obligation to utilize the funds in any particular way, Relator has failed to plead an FCA or NYFCA claim. The court explained that because the Medicare and Medicaid payments at issue here were reimbursements for services already provided, with no forward-looking conditions that they be used in any particular way, Defendants’ alleged conduct did not violate the Benefits Conversion Statute. Relator’s claims based on section 1320a-7b(a)(4) therefore fail as a matter of law.
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