Filed: Aug. 11, 2004
Latest Update: Feb. 21, 2020
Summary: United States Court of Appeals Fifth Circuit F I L E D IN THE UNITED STATES COURT OF APPEALS August 11, 2004 FOR THE FIFTH CIRCUIT Charles R. Fulbruge III Clerk No. 03-50507 United States of America, ex rel., TONI R. BARRON; VICKY J. SCHEEL, Plaintiffs-Appellants, versus DELOITTE & TOUCHE, L.L.P.; DELOITE & TOUCHE CONSULTING GROUP, L.L.C.; DELOITTE & TOUCHE CONSULTING GROUP HOLDING, L.L.C.; MEDICAID CLAIM SOLUTIONS OF TEXAS, INC.; NATIONAL HERITAGE INSURANCE CO., Defendants-Appellees. Appeal fro
Summary: United States Court of Appeals Fifth Circuit F I L E D IN THE UNITED STATES COURT OF APPEALS August 11, 2004 FOR THE FIFTH CIRCUIT Charles R. Fulbruge III Clerk No. 03-50507 United States of America, ex rel., TONI R. BARRON; VICKY J. SCHEEL, Plaintiffs-Appellants, versus DELOITTE & TOUCHE, L.L.P.; DELOITE & TOUCHE CONSULTING GROUP, L.L.C.; DELOITTE & TOUCHE CONSULTING GROUP HOLDING, L.L.C.; MEDICAID CLAIM SOLUTIONS OF TEXAS, INC.; NATIONAL HERITAGE INSURANCE CO., Defendants-Appellees. Appeal from..
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United States Court of Appeals
Fifth Circuit
F I L E D
IN THE UNITED STATES COURT OF APPEALS
August 11, 2004
FOR THE FIFTH CIRCUIT Charles R. Fulbruge III
Clerk
No. 03-50507
United States of America, ex rel., TONI R. BARRON;
VICKY J. SCHEEL,
Plaintiffs-Appellants,
versus
DELOITTE & TOUCHE, L.L.P.; DELOITE & TOUCHE
CONSULTING GROUP, L.L.C.; DELOITTE & TOUCHE
CONSULTING GROUP HOLDING, L.L.C.; MEDICAID
CLAIM SOLUTIONS OF TEXAS, INC.; NATIONAL
HERITAGE INSURANCE CO.,
Defendants-Appellees.
Appeal from the United States District Court for
the Western District of Texas
(USDC No. SA-99-CV-1093)
_______________________________________________________
Before KING, Chief Judge, REAVLEY and EMILIO M. GARZA, Circuit Judges.
REAVLEY, Circuit Judge:*
*
Pursuant to 5TH CIR. R. 47.5, the Court has determined that this opinion should
not be published and is not precedent except under the limited circumstances set forth in
5TH CIR. R. 47.5.4.
The district court’s judgment is reversed. The liability of National Heritage is
explained by an accompanying published order. Further, the record raises issues
supporting the claim of relators that they were the original source.
In order to determine whether the relators were an original source, a two part test
must be satisfied:
(1) the relator must demonstrate that he or she has “direct and independent
knowledge of the information on which the allegations are based” and (2)
the relator must demonstrate that he or she has “voluntarily provided the
information to the Government before filing” his or her qui tam action.
United States ex rel. Laird v. Lockheed Martin Eng’g,
336 F.3d 346, 352 (5th Cir. 2003).
Evidence that Relator Scheel provided medical services at one of the relevant public
school districts, Relator Scheel’s affidavit concerning Deloitte & Touche’s presentation
on Medicaid billing, along with evidence of possible fraudulent activities, is sufficient to
satisfy the competent evidence standard of direct knowledge. As for independent
knowledge, Relators’1988 complaint was filed prior to the relevant public disclosure.
There is evidence that Relators voluntarily provided the information to the
government before filing this qui tam suit. The new evidence presented on this issue in
the reply brief is disregarded, as it should have been presented to the trial court. See
United States v. One 1978 Piper Navajo PA-31 Aircraft,
748 F.2d 316, 319 (5th Cir.
1984). Instead, the original qui tam complaint and disclosure statement, which contained
2
“substantially all material evidence and information” in Barron and Scheel’s possession
regarding the allegedly fraudulent activities, were served on the government in April 1998
several months prior both to the June 1999 Senate hearings and to the filing of the present
suit. See Luke Declaration, R. at 616.
All pending motions not acted on here are DENIED.
REVERSED and REMANDED.
3
EMILIO M. GARZA, Circuit Judge, dissenting:
The majority opinion concludes that the relators are an original source of the
information on which the allegations in the relators’ qui tam action are based. I disagree.
To establish that they are an original source, the relators must show that they (1) have
independent knowledge of the information; (2) have direct knowledge of the information;
(3) and have voluntarily provided the information to the government before filing their qui
tam action. See United States ex rel. Laird v. Lockheed Martin Eng’g and Science Servs.
Co.,
336 F.3d 346, 352 (5th Cir. 2003). The relators have not shown that they have
direct knowledge of the information, and accordingly I dissent.
The majority opinion states that “evidence that Relator Scheel provided medical
services at one of the relevant school districts, Relator Scheel’s affidavit concerning
Deloitte & Touche’s presentation on Medicaid billing, along with evidence of possible
fraudulent activities, is sufficient to satisfy the competent evidence standard of direct
knowledge.” ___ F.3d ___ (Majority Opinion at 2). Notably, the majority opinion does
not claim to find any evidence to show that Relator Barron had direct knowledge of the
information. Relator Barron presented no evidence before the district court to show that
she had direct knowledge, and therefore she cannot be an original source of the
information.
The evidence cited by the majority opinion also fails to establish that Relator
Scheel has direct knowledge of the information. Direct knowledge is “knowledge derived
from the source without interruption or gained by the relators own efforts rather than
learned second-hand through the efforts of others.”
Laird, 336 F.3d at 355. The court
must distinguish between “those individuals who, with no details regarding its
whereabouts, simply stumble upon a seemingly lucrative nugget and those actually
involved in the process of unearthing important information about a false or fraudulent
claim.”
Id. at 356. The mere fact that Relator Scheel provided medical services at one of
the relevant districts does not show that Scheel learned the information through her own
efforts. Similarly, Scheel’s affidavit does not establish that she has direct knowledge of
the information. It merely provides that she was a physical therapist who provided
services to Medicaid eligible children and that she attended a training session in which a
Deloitte and Touche representative spoke about billing procedures, documentation
requirements and Medicaid rules. The affidavit does not specify what the Deloitte and
Touche representative said about these procedures, requirements and rules, nor does the
affidavit state that she saw the billing procedures being used. Scheel does not even state
that she was trained to follow questionable billing procedures at this training session,
merely that billing procedures were discussed.
Scheel also provided a one-page transcript of the training session, which at most
shows the Relators had direct knowledge that service rates included time spent in
Admission, Review and Dismissal (“ARD”).1 The transcript does not address relevant
information such as improper billing of transportation costs, bundled payments or the
1
This could be connected to the Relators’ allegations in ¶ 31 of their complaint.
-5-
failure to differentiate between skilled and unskilled activities. The Relators have not
provided sufficient evidence to establish that they had direct knowledge of the publicly
disclosed information. Accordingly, the Relators cannot be an original source of the
information. See
Laird, 336 F.3d at 352. The district court correctly dismissed the case
for lack of jurisdiction.
For the above reasons, I respectfully dissent.
-6-