having judges the district court order granting motions to dismiss should be overturned the district court aired and determining that the related claims are subject to the public disclosure bar and that the relator is not an survive the public disclosure i've been has identified such cases as being unique because they are this is not a typical settlement where i defendant pay settlement fund that admits no why building when integrity agreement or an i may be referring to it at times this morning is entered into the defendant is essentially acknowledging the fraud promising that it will and setting forth that's to satisfy the government that future fraud will not occur the government and the public are short by these agreements the fraud has been rooted out and that it will and that expectation is evident by the department of justice press really issued in two thousand and thirteen when deming was had review responsibilities they would review the records and claim to generated by dr corrigan and delta their review is based on information documents that were supplied to they that prepared reports regarding their review and supplied those reports to the inspector general so that went through two thousand the point of this iroh was to investigate whether the fraud was continuing and so that that that seems to take it out of i mean i get the idea that you could have a world which a continuing violation becomes new or material where you have sorts of new public disclosure i get all of that minute situation where you've you've got this iraq and the allegations over solely with the iraq and their jurisdiction up to sixteen that seems different it's almost as if you have a grand jury sitting and thinking about similar allegations and that has  eyes and as i am the i am in this case so much like you just did see this report stated that i but then i am only required the adoption of procedures designed to ensure future complian whereas the i and this case was different and it entailed ongoing reporting requirements to the government but the district court findings in this regard were incorrect because and i bet that there was not one but two  integrity agreements that were in play both of which were affected for a five year period at the time and which required ongoing reporting to the government i do not know for certain if that was accomplished by the use of an i suggested you not read you need to look at us because you are you can't hear us for some reason so we'll raise our hand but you can't see our hand if you to look at the camera on asking about is the situation where there's an independent review so you have the answer that question does doesn't help any to talk about iben as when it didn't have the independent review i mean it may not be dispositive that's why i'm  question i have no i right that was the point that i was trying to make is that i've been as was an abstract for five years and i've been as entailed ongoing reporting  ongoing reporting obligations which were in effect at the time that i've been as was filed ivan has just committed to move forward because that was later was bringing forth new information which was that the fraud had continued or  started after the integrity agreement had been entered into as that and as for observe the government is not necessarily aware that a fraudulent scheme  begin your complaint yes our i believe that the integrity agreement expired in november of two thousand and sixteen and that most of our allegations stem from events that domain indicating that the broad had continued or restarted after the execution of the integrity agreement rather all information to kids that the deming relator had revealed a fraud many years earlier that the fraud had been well i would say that the public disclosure bar only applies when the relator is not presenting any new information and that my client is presenting new information that was not real in the earlier public disclosures my client has revealed a new story where the fraud has continued after the execution of the integrity agreement and along the same line  fraud has continued after the execution of the integrity agreement and the promise to just continue the fraud counsel help me understand you or your client has six examples after the integrity agreement was entered into but what if you only had one so what is the statute says materially adds so he had one example that took place after the integrity agreement had been entered into or the settlement with the regional hospital would that be enough what what should we make of materially what does it mean to materially add well i think that he is not only operating those patient examples but he's also offering his st camp personal observations and that's something that we talk a lot about in the a complaint he's offered his observations of patient treatment is reviewed the record is observation that some of the records are being falsified a patient saying they don't have chest pain and then the record stating that counsel those aren't observations that would go directly to see enter for example like oh well we had a meeting and we told everybody to cover this up or submit false claims or they're just observations about patient almost set a time so i want to hear the district court rules on ninety grounds with respect to c h s the hospital defendants have said we should extend that ruling to them so st would you be how would you be harmed if we did that and secondly what about extending that ruling to corban and the delta clinics in other words it's just  understand they didn't raise it but it is a pure question of law and it would seem to me to apply similarly to all the fed then when you did have a chance to argue it in the district court with respect to the one defendant so how would your client be harmed if we did that other than that well i mean as i indicated our reply brief we think th denied motion to dismiss when that issue has not been raised on appeal and i clearly i'm out of time and so i i would just defer to our written submission bring the other questions ok thank you so much  district court dismissed the quake tam binding it was barred by the public disclosure bar because the allegations in the amended complaint were previously publicly disclosed and substantially the same as those in the  we believe that it gives this court the opportunity to address situations where hosts settlement or pose resolution of the case there is the conditional resolution where the o o g is has a cia with an arrow in place monitored by the o o g versus a situation where of the jews relying on a self disclosure based on the serac said that the only thing the independent review or has is whatever the doctor or the folks you know they're not going to give damning stuff to the independent review or the independent review or assign status and different spot checks or interviewing people or maybe they are they depend on the interviewing patients you're gonna let me address the question that you've asked for the the independent review organization is typically a law firm accounting firm or consulting firm they are independent of the provider even though they're played by the provider their responsibility is to the they have the om they have the  automating and monitoring functions of the o r g they're called the eyes and ears of the elachi they are they they conduct here it was a comprehensive ah ha that involved extensive review of coding billing and reimbursement of all cardiology items and services paid for by the federal government as well as subsequent medical reviews of a litany of cardiac procedures so this is a this is  fully engaged independent organization conducting a review that is responsible for own going communication with the o r g ok so so that all sounds good but do they actually have  auditing fact finding authority could they go and say ok there's this one time they put a stent in we're going to go and interview we're going to go look at what happened we're going to go look at the prior diagnosis we're going to talk to the patient we're going to find out whether what he said in the report is consistent with what he complained about when he went to the doctor can they do that absolutely you're on the the independent review organization can review records they can conduct interviews they can conduct interviews outside of the provider they fact find yes it's our view that the role of the independent reorganization is to not make legal conclusions but what they do is they determine deficiencies and if those deficiencies ra's to the level of what is called the reportable of them the reportable of it is reviewed by the provider and maybe their outside coun have material breach where they exclude the provoked or significantly here the o o g can make a report or rule to the department of justice civilly and or criminally for the conduct so the government has a mechanism here in place national so ready next question is let's let's say the complaint was different everything else is the same but this complaint is only about january two thousand and eighteen going forward and it's if you know it's he's up to his old tricks it uses some of the same things from the original complaint but everything is after the arrows gone and they're the same they're substantially similar but it is new i take it you wouldn't have a public disclosure bar there right your honor the issue is no no is the answer the issue is government awareness government notification and expectation and us and they monitored by the united states government monitored by the o r g you have that and that is that that is better than that as that is they are much more qualified and they are better suited to conduct a review of this provider than a profit litigant who here we would argue is simply a this is simply an opportunist opportunistic line of fallen a parasitic lawsuit bad be investigated organization i mean where people can pick it up out of the internet or any other place well as far as public disclosure the the case following the doing complaint was  media accounts there after with the settlement or public disclosures we would argue that the corporate integrity agreement itself is a public disclosure because if you're familiar with them you know they don't i don't think you're answering josiah this question he wants to know how public the i r o work is so you have this private consultant it's that public the answer is the r o reports go to the provider and they are produced t g ok the issue is and is is government awareness government expectation of the continuation of for all and we have that within our o in place and of the statute well the original problem most publicly disclosed and now the question is whether this new complaint materially adds is that how you think about it or how do you how do you look at in terms of the statute because if the government awareness government expectation in the government clearly from the beginning and throughout the duration of this r o the duration of the cia or three years the government was there looking into this for bottom i mean the the district court said the o r g retained ultimate supervisory authority over bring in the hospitals and as he alleges that the hospital should have known the hospital should have known that dr corman was performing unnecessary procedures for two reasons one he says because the number of procedures that are being performed to because he alleges that complaints are made to hospital committees about doctor or those folks to the hospital a number of procedures and the complaints that is lifted verb eight i'm from deming so as it relates to the hospital continued just because it was settled before the court want to assume that but only if the new allegations are orally distant from the resolve combat as it relates to the hospitals the hospital saddled  later we decided numerous cases to the court from both the circuit and other circuits that bringing a new key can based on publicly discuss disclose conduct from less than a year before wouldn't be tempora february th or february th how the court determines whether or not the period of time is is when the court when the government would still expect fraud to continue going to depend on the particular facts and circumstances here  the fact about what the government would have expected is that there was an integrity agreement and place with the government having the possibility of reviewing the exact kinds of claims that our raises are point the court to mauer actually describes in his own complaint what an integrity agreement is and what he says quote one of the purposes for binding violators to an integrity agreement after settling and was not an employee of the hospital i think that dr corbin worked as a contractor for the hospital and may have been a by the hospital for some services that it that he provided to the hospital like reading e k g s or things like that that he was not and go away that's correct he was not an employee for i also want to address the court and i have a  i'm just focusing on the statute for a and for b for a has public disclosure right and then substantially the same allegations right that inquiry then you have this in for or a definition of original source of material that's how does one how does one look at that what is there a sequencing you look at one before the other is are they for different purposes there's a great deal of overlap between whether something is substantially the same and materially add in a lot of courts confused by me to the way that the analysis is supposed to work is as as this cour other words you would look at this case and you would say this complaint doesn't say is a substantial it is substantially the same allegations because it repeats the same problem just for a different time period different victims say you fail under that ground but the client claimant is allowed to say but despite all that he said original source and the original source might be violating the agreement by leaving the i f a i'm not i'm in the right sequence that is the right sequence in the court has to consider two factors how much time has passed between the public disclosure and the new key thing and and then what is the nature of the new new allegations here if the court complaint dr deming allege that he was basing his allegations on the fact that he served on a quality assurance committee at the hospital he had been a five specific physicians you had complained about  mauer wasn't so bald as to try to copy those allegations all he did was copy the conclusions that dr deming had had had raised but he has he has no basis for doing that and so that's  why why isn't a more charitable way to look at this put the iro to the side of the street ten there is no iroh bytes in a more charitable way to look at this that the material yachts requirement is simply met by the before or has the defendants are always going to argue for a high level of generality if there is medicare my level of generality as i am leaving the settlement agreement why is that not the right level of generality you can come back and say the ira accounts for that and therefore you can't do anything before the end of two thousand and sixteen but that matters not just republicans for sure it matters for not for nine b as well you just write that that overlap makes sense but it also is launching you into a new argument which i as a former advocate i would do exactly what you're doing the case was very clear that the temporal distance is measured between the result of conduct and the new allegation not the date of an agreement that resolves the bad conduct but the date of the result of conduct itself resolve conflicts in other words like how should we what you say there are all these cases that stand for that proposition maybe you could tell me other than by yes or the case that i think all the parties have cited to and that temporal distance was measured from the result of conduct their two thousand and eight was established as the cutoff line there and that was when that was the date of the result contact which so if you were listening to that conversation i was making the point that perhaps and i would geishas that it's a violation of the settlement agreement a violation of the i a e a gets you outside the public disclosure part because the material orks response was well that might be true in the abstract but all the complaint does is simply repeat the prior busy allegations find in the st complaint and simply adds the conclusion that the settlement agreement was violated that seems like a fair point so you're it seems to me your answer to that should be well no no here is what is here's what we did we showed a required training for employees which we submit never occurred at least my client was never made to go through any training like hire relation and then for he told by the office manager don't worry about it we'll just write down on this piece of paper that you did it when in fact nobody really did it and we also talked about how dr corben actively undermined the medical judgment at the physicians in the practice and they would say we don't think any procedures are necessary and they would come along and say yes they are and then like i mentioned earlier we also have allegations in the complaint regarding a actively misrepresenting the patient's condition in the medical records so that you c i think that's what i heard of those the two essential points i don't think that there are allegations from deming regarding active undermining of other physicians and the practice actively undermining their medical judgment or actively  complicated cases so we're really grateful for the briefing and argument thanks very much the case will be submitted your next