### In the



# United States Court of Appeals

For the Seventh Circuit

No. 15

‐ 3473

G EORGE B ELLEVUE

, Plaintiff

‐ Appellant

,

v.

U NIVERSAL H EALTH S ERVICES OF

H ARTGROVE

, I NCORPORATED

, doing

business as H ARTGROVE H OSPITAL

, Defendant

‐ Appellee.

Appeal from the United States District Court for the

Northern District of Illinois, Eastern Division.

No. 11 C 5314

— Thomas M. Durkin

, Judge.

A RGUED F EBRUARY 15, 2017

— D ECIDED A UGUST 8, 2017

Before B AUER

, E ASTERBROOK

, and H AMILTON

, Circuit Judges

.

B AUER

, Circuit Judge. Relator and plaintiff

‐ appellant George

Bellevue filed a qui tam action under the False Claims Act

(FCA), 31 U.S.C. § 3729 et seq

., and its Illinois analog, the

Illinois False Claims Act (IFCA), 740 Ill. Comp. Stat. 175/12 No. 15

‐ 3473

et seq

., on behalf of the United States and the State of Illinois

against defendant

‐ appellee Universal Health Services of

Hartgrove, Incorporated (“Hartgrove”). Bellevue argues that

Hartgrove violated the FCA under a number of theories,

including false certification and fraudulent inducement. The

district court granted Hartgrove’s motion to dismiss the

complaint for failure to state a claim of fraud with particularity

as required by Federal Rules of Civil Procedure 12(b)(6) and

9(b).

I. BACKGROUND

Hartgrove is a psychiatric hospital that primarily serves

children with mental illness. It is enrolled with the Illinois

Department of Healthcare and Family Services to receive

reimbursement for treating patients through Medicaid. On

April 8, 2004, Hartgrove signed a Provider Enrollment Appli

‐

cation certifying that it understood “that knowingly falsifying

or wilfully withholding information may be cause for termina

‐

tion of participation” in the State’s Medical Assistance Pro

‐

gram. It further certified that it was in compliance with all

applicable federal and state laws and regulations.

On the same date, Hartgrove signed an Agreement for

Participation in the Medical Assistance Program, in which it

agreed to comply with all federal and state laws and regula

‐

tions. Hartgrove agreed “to be fully liable for the truth,

accuracy and completeness of all claims submitted

... to the

Department [...] for payment.” It also promised that “all

services rendered on or after [the effective date of the agree

‐

ment] were rendered in compliance with and subject to the

terms and conditions” of the agreement. Upon receipt ofNo. 15

‐ 3473 3

Medicaid reimbursements, Hartgrove is required to certify that

the services provided in the billing information were actually

provided.

Hartgrove’s license, issued by the Illinois Department of

Public Health, permits it to maintain 150 beds for patients with

acute mental illness, but it actually maintains 152 beds. Prior

to September 30, 2009, Hartgrove was permitted to maintain

136 beds for acute mental illness patients. Newly admitted

adolescent patients suffering from acute mental illness are

placed in a room used for daytime group therapy, known as a

“dayroom,” rather than patient rooms. These patients sleep on

rollout beds until a patient room becomes available. This

occurred on 13 separate occasions between January 1, 2011,

and June 3, 2011. Hartgrove submitted claims for inpatient care

to Medicaid on behalf of these patients even though they were

not assigned a room.

Bellevue joined the Hartgrove staff in October 2009, serving

as a nursing counselor until October 2014. He contends that

Hartgrove knowingly submitted fraudulent claims for reim

‐

bursement to Medicaid by admitting new patients with acute

mental illness in excess of its 150

‐ bed capacity and permitting

these patients to sleep in the dayroom rather than in a private

room. He further contends that Hartgrove certified, “either

explicitly or implicitly,” that it was in compliance with licens

‐ ing standards contained in state law, rules, and regulations,

even though it was over capacity. See Ill. Admin. Code tit. 77,

§ 250.230(b). Prior to filing his complaint, Bellevue voluntarily

provided the information on which his allegations are based to

federal and state government authorities.4 No. 15

‐ 3473

Bellevue filed suit on August 5, 2011; the United States

and the State of Illinois declined to intervene. Hartgrove

moved to dismiss the complaint under Rules 12(b)(1), 12(b)(6),

and 9(b), on December 29, 2014. Specifically, Hartgrove

argued that Bellevue’s suit was foreclosed by the FCA’s public

‐

disclosure bar, which deprived the district court of

jurisdiction. 1 It also argued that Bellevue’s complaint failed

on the merits. The district court disagreed with Hartgrove’s

jurisdictional argument, but agreed that Hartgrove failed on

the merits; the court granted the motion without prejudice

on April 24, 2015.

Bellevue filed an amended complaint on June 26, 2015.

Hartgrove moved to dismiss on July 13, 2015, renewing its

arguments from the previous motion. The district court found

that Bellevue failed to state a claim, and the court granted the

motion with prejudice on October 5, 2015. Bellevue filed a

motion to reconsider in light of the United States Supreme

Court’s decision in Universal Health Services, Inc. v. United States

ex rel. Escobar

, 136 S. Ct. 1989, 1999 (2016), in which the Court

1 In support of its motion, Hartgrove attached a March 23, 2009, letter from

the Illinois Department of Public Health and a May 5, 2009, letter and report

from the U.S. Centers for Medicare & Medicaid Services that disseminated

findings from two IDPH audits conducted in March 2009. IDPH found that

Hartgrove’s patient count exceeded the number it was permitted under its

license on both audit dates, and therefore was “over census.” The CMS

report noted that Hartgrove was over census on at least 52 separate

occasions between December 3, 2008, and February 28, 2009. These

materials were properly before the district court because they were

submitted to determine whether subject

‐ matter jurisdiction existed. See

Evers v. Astrue

, 536 F.3d 651, 656–57 (7th Cir. 2008) (citation omitted).No. 15

‐ 3473 5

held that an implied false certification theory is a viable basis

for liability under the FCA. The district court denied the

motion on October 20, 2015, finding that Bellevue’s amended

complaint failed to state a claim for implied false certification.

This appeal followed.

II. DISCUSSION

The FCA permits “both the Attorney General and private

qui tam relators to recover from persons who make false or

fraudulent claims for payment to the United States.” Graham

Cnty. Soil & Water Conservation Dist. v. United States ex rel.

Wilson

, 559 U.S. 280, 283 (2010). To establish civil liability

under the FCA, a relator generally must show that “(1) the

defendant made a statement in order to receive money from

the government; (2) the statement was false; (3) the defendant

knew the statement was false; and (4) the false statement was

material to the government ʹ s decision to pay or approve the

false claim.” United States ex rel. Marshall v. Woodward, Inc

., 812

F.3d 556, 561 (7th Cir. 2015) (citation omitted). 2

The FCA also seeks to prevent parasitic lawsuits by

“opportunistic plaintiffs who have no significant information

2 The IFCA “closely mirrors the FCA,” and to date we have not found any

difference between the statutes that is material to a jurisdictional or merits

analysis. United States ex rel

. Absher v. Momence Meadows Nursing Ctr., Inc.

,

764 F.3d 699, 704 n.5 (7th Cir. 2014); see also United States ex rel. Kennedy v.

Aventis Pharms., Inc

., 512 F. Supp. 2d 1158, 1163 n.2 (N.D. Ill. 2007) (“Case

law regarding the FCA is also applicable to the [IFCA].”); Scachitti v. UBS

Fin. Servs

., 831 N.E.2d 544, 557–59 (Ill. 2005) (applying FCA case law to a

jurisdictional analysis of the IFCA). The district court applied its analysis of

the FCA equally to the IFCA claims. We will proceed in the same fashion.6 No. 15

‐ 3473

to contribute of their own

... .” Graham Cnty.

, 559 U.S. at 294

(citation omitted). In furtherance of this goal, Congress enacted

the public

‐ disclosure bar because “[w]here a public disclosure

has occurred, [the relevant governmental] authority is already

in a position to vindicate society’s interests, and a qui tam

action would serve no purpose.” United States ex rel. Feingold v.

AdminaStar Fed., Inc

., 324 F.3d 492, 495 (7th Cir. 2003) (citation

omitted).

On appeal, Hartgrove argues that the district court erred

in its finding that the FCA’s public

‐ disclosure bar contained in

31 U.S.C. § 3730(e)(4) did not apply to Bellevue’s claims; a

decision that we review de novo

. United States ex. rel. Heath v.

Wis. Bell, Inc

., 760 F.3d 688, 690 (7th Cir. 2014) (citation omit

‐ ted). In 2007, the Supreme Court held that § 3730(e)(4) is a

jurisdictional requirement that must be addressed before a

court can reach the merits of the FCA claims. Rockwell Int’l

Corp. v. United States

, 549 U.S. 457, 467–70 (2007). Therefore, we

address this issue at the outset.

Congress amended the public

‐ disclosure bar in March 2010.

Because Bellevue’s allegations extend from August 5, 2005, to

the present, 3 covering both pre ‐ and post

‐ amendment time

periods, we examine both versions of the statute.

3 Although Bellevue contends that Hartgrove submitted false claims from

August 2001 to the present, the district court dismissed Bellevue’s claims

that arose prior to August 5, 2005, due to the FCA’s six

‐ year statute of

limitations. See 31 U.S.C. § 3731(b)(1). It also dismissed Bellevue’s claims in

his individual capacity. Bellevue does not challenge either action by the

district court, so we need not address these claims further.No. 15

‐ 3473 7

Prior to the 2010 amendments, § 3730(e)(4) provided:

(A) No court shall have jurisdiction over an

action under this section based upon the public

disclosure of allegations or transactions in a

... congressional, administrative, or Government

Accounting Office report, hearing, audit, or

investigation

... unless

... the person bringing

the action is an original source of the informa

‐

tion.

(B) For purposes of this paragraph, “original

source” means an individual who has direct and

independent knowledge of the information on

which the allegations are based and has volun

‐ tarily provided the information to the Govern

‐

ment before filing an action under this section

which is based on the information.

After the 2010 amendments, § 3730(e)(4) provides:

(A) The court shall dismiss an action or claim

under this section, unless opposed by the Gov

‐

ernment, if substantially the same allegations or

transactions as alleged in the action or claim

were publicly disclosed

... in a congressional,

Government Accountability Office, or other

Federal report, hearing, audit, or investigation

... unless

... the person bringing the action is an

original source of the information.

(B) For purposes of this paragraph, “original

source” means an individual who

... has knowl

‐8 No. 15

‐ 3473

edge that is independent of and materially adds

to the publicly disclosed allegations or transac

‐

tions, and who has voluntarily provided the

information to the Government before filing an

action under this section. 4

As an initial matter, we have noted that Congress removed

the phrase “[n]o court shall have jurisdiction over an action

under this section” and replaced it with “[t]he court shall

dismiss an action or claim under this section” in the 2010

amendment to § 3730(e)(4)(A). Absher

, 764 F.3d at 706. The

Supreme Court’s holding in Rockwell regarding the jurisdic

‐

tional nature of the public

‐ disclosure bar was based on the

inclusion of the phrase “[n]o court shall have jurisdiction over

an action under this section.” Id

. (citing Rockwell

, 549 U.S. at

467). Because this language has been removed from the statute,

it is unclear whether the language of the 2010 amendment

is jurisdictional. Cause of Action v. Chi. Transit Auth.

, 815 F.3d

267, 271 n.5 (7th Cir. 2016). We have previously noted that

other circuits have found that the language of the 2010 amend

‐

ment is not jurisdictional, but we have declined to decide this

issue in our circuit. Id

. Because some of Bellevue’s allegations

occurred pre

‐ amendment, we address the public

‐ disclosure bar

as a jurisdictional one. See id. (applying the pre

‐ amendment

version of § 3730(e)(4)(A), where the contested conduct

spanned both pre ‐ and post

‐ amendment time periods).

4 Shortly after the public

‐ disclosure bar of the FCA was amended, the

IFCA was amended and re

‐ codified effective July 27, 2010. The amendments

mirror those of the FCA. See 740 Ill. Comp. Stat. 175/4 (2010).No. 15

‐ 3473 9

In addition, we have held that the amendment to

§ 3730(e)(4)(A) involved “a change to what constitutes a ‘public

disclosure,’” and thus is a substantive change that is not

retroactive. United States ex. rel. Bogina, v. Medline Indus., Inc.

,

809 F.3d 365, 369 (7th Cir. 2016) (citation omitted). Conse

‐ quently, “the pre

‐ 2010 version of [§ 3730(e)(4)(A)] governs

conduct that occurred in that era while the new version

governs only more recent conduct.” Id

. at 368 (collecting cases).

However, this change is not significant, as “we have previously

interpreted the phrase ‘based upon [a] public disclosure’ to

mean ‘substantially similar to publicly disclosed allegations’

... .” Leveski v. ITT Educ. Servs., Inc

., 719 F.3d 818, 828 n.1 (7th

Cir. 2013) (citation omitted); see also Bogina

, 809 F.3d at 368

(noting that the change in statutory language is not significant).

The current version of the statute expressly incorporates the

“substantially similar” standard in accordance with the

interpretation of this circuit and most other circuits

. Leveski

,

719 F.3d at 828 n.1.

In contrast to § 3730(e)(4)(A), our cases have found that

the amendment to the “original source” definition in

§ 3730(e)(4)(B) is a clarification rather than a substantive

change, and therefore is retroactive. Bogina

, 809 F.3d at 369;

see also Cause of Action

, 815 F.3d at 283 n.22 (citing Bogina

, 809

F.3d at 368–69) (applying the 2010 definition of original source

to conduct occurring prior to 2010). Because the district court

decided the instant case prior to Bogina and Cause of Action

, we

take a fresh look to ensure that subject

‐ matter jurisdiction is

present.

Hartgrove argues that Bellevue’s claims were publicly

disclosed by the IDPH and CMS letters and audit report from10 No. 15

‐ 3473

March and May 2009. Determining whether to apply the

public

‐ disclosure bar requires the court to complete a three

‐

step inquiry. First, we examine whether the relator’s allega

‐

tions have been “publicly disclosed.” Cause of Action

, 815 F.3d

at 274 (citation omitted). If so, we next ask whether the lawsuit

is “based upon,” i.e

., “substantially similar to” the publicly

disclosed allegations. Id

. (citation omitted). “If it is, the public

‐

disclosure bar precludes the action unless ‘the relator is an

original source of the information upon which the lawsuit is

based.’” Id

. (citation and brackets omitted). “The relator bears

the burden of proof at each step of the analysis.” Id

. (citation

omitted).

Applying the three

‐ step framework, we first address

whether Bellevue’s allegations were publicly disclosed. “[T]he

allegations in a complaint are publicly disclosed when the

critical elements exposing the transaction as fraudulent are

placed in the public domain.” Id

. (citation and quotation marks

omitted). “This definition presents two distinct issues: whether

the relevant information was placed in the public domain, and,

if so, whether it contained the critical elements exposing the

transaction as fraudulent.” Id

. (citation and quotation marks

omitted).

Bellevue does not dispute that the information was in the

public domain; he contends that the letters and audit report

state merely that Hartgrove was over census without any

reference to a knowing misrepresentation of facts, which is a

critical element of fraud. The district court found that the

government had enough information to infer scienter from the

results of its audits. We agree. We have held that the public

‐

disclosure bar applied in instances “where one can infer, as aNo. 15

‐ 3473 11

direct and logical consequence of the disclosed information,

that the defendant knowingly—as opposed to

negligently—submitted a false set of facts to the Government.”

Id

. at 279 (citing Absher

, 764 F.3d at 709 n.10).

Bellevue relies on Absher

, in which we held that the govern

‐

ment’s knowledge that the defendant had failed to comply

with a patient’s standard of care did not necessarily mean that

the defendant had knowingly misrepresented its compliance

when requesting payments from the government. 764 F.3d at

708–09. As we recognized in Cause of Action

, decisions regard

‐ ing a patient’s standard of care involve “qualitative judg

‐

ments,” and thus there was an equally plausible inference that

the Absher defendant’s error was a mistake rather than a

knowing violation. 815 F.3d at 279. Therefore, it was inappro

‐ priate to apply the public

‐ disclosure bar in Absher

.

Here, as in Cause of Action

, the audit report and letters

provided a sufficient basis to infer that Hartgrove was present

‐ ing false information to the government. See id

. The kind of

qualitative judgments at issue in Absher are not present in this

case. As the district court noted, because Bellevue did not

have personal knowledge of Hartgrove’s billing practices, his

allegations necessarily required him to infer that Hartgrove

was knowingly over census. There is no reason that the

government could not have made the same inference based on

its audits. Therefore, we find that Bellevue’s allegations were

publicly disclosed.

Moving to the second step, we address whether Bellevue’s

allegations are substantially similar to the publicly disclosed

allegations. There are several factors courts consider in12 No. 15

‐ 3473

determining whether this standard is met: whether relators

present genuinely new and material information beyond what

has been publicly disclosed; whether relators allege “a differ

‐

ent kind of deceit”; whether relators’ allegations require

“independent investigation and analysis to reveal any fraudu

‐

lent behavior”; whether relators’ allegations involve an entirely

different time period than the publicly disclosed allegations;

and whether relators “supplied vital facts not in the public

domain[.]” Cause of Action

, 815 F.3d at 281 (collecting cases).

The district court found that Bellevue’s allegations concern

‐ ing Hartgrove’s conduct through May 5, 2009 (the issuance

date of CMS’s letter), are substantially similar to the publicly

disclosed allegations. 5 However, it found that Bellevue’s

allegations that Hartgrove continued its billing practices

beyond May 5, 2009, involves a different time period. Thus, it

concluded that Bellevue’s claims concerning conduct after

May 5, 2009, are not substantially similar to the publicly

disclosed allegations.

We agree with the district court as to Bellevue’s allegations

through May 5, 2009. Bellevue’s complaint describes the same

contested conduct and pertains to the same entity. In addition,

the time periods overlap. Furthermore, Bellevue did not

5 Hartgrove correctly points out that the 2010 amendments to

§ 3730(e)(4)(A), added the qualification that an audit report must be

“Federal” in order to qualify as a public disclosure, and the IFCA amend

‐

ment correspondingly limited public disclosures to “State” audit reports, see

740 Ill. Comp. Stat. 175/4 (2010). Therefore, after the 2010 amendments, the

May 5, 2009, CMS audit report and letter is relevant to Bellevue’s FCA

claims, and the March 23, 2009, IDPH audit and letter is relevant to his

IFCA claims.No. 15

‐ 3473 13

supply any genuinely new and material information in his

amended complaint. Bellevue argues that his allegation that

Hartgrove knowingly exceeded its capacity constitutes new

information, but as we stated above, scienter can be inferred

from the audit report and letters. Bellevue also argues that he

provided new information by alleging that Hartgrove ex

‐

ceeded its capacity as part of its regular business practice as

opposed to a temporary measure resulting from an emergency.

This is, at best, a conclusory allegation that lacks any factual

support. We have found that such conclusory allegations fail

to meet the particularity standards required by Rule 9(b), and

therefore are insufficient to evade the public

‐ disclosure bar. See

Bogina

, 809 F.3d at 370.

As to Bellevue’s post

‐ May 5, 2009, allegations, we must

disagree with the district court in light of our recent holding in

Cause of Action

. We recognize that in Leveski

, we found that the

relator’s allegations were not substantially similar to those

contained in a previous lawsuit because they involved a

different time period. See 719 F.3d at 829–30. But in arriving at

this conclusion, we also considered that the relator’s allega

‐

tions involved wrongdoing by a separate department, per

‐

tained to a more sophisticated scheme, and named specific

individuals. See id

. at 830–33.

In Cause of Action

, we found that although the audit report

had considered conduct through 2004, the defendant’s conduct

in subsequent years was part of its “continuing practice” of

misreporting data to the government. 815 F.3d at 278 n.14. We

held that the relator’s claim of a continuing practice “does not

warrant our characterizing [the relator’s] allegations as not

substantially similar” to the allegations disclosed in the audit14 No. 15

‐ 3473

report. Id. at 281–82; see also Bogina

, 809 F.3d at 370 (finding that

relator’s allegation that the fraud continued to present day,

along with other minor details, was an “unimpressive”

difference from a previous complaint and did not preclude

application of the public

‐ disclosure bar). Here, as in Cause of

Action

, Bellevue’s allegations pertain to the same entity and

describe the same contested conduct as the publicly disclosed

information. Therefore, we find that Bellevue’s post

‐ May 5,

2009, allegations, are substantially similar to the publicly

disclosed allegations.

Moving to the third step, we ask whether Bellevue was an

original source of the information upon which the allegations

in his complaint were based. The district court, applying the

pre

‐ 2010 definition of original source, found that although

Bellevue did not allege that he had direct knowledge of

Hartgrove’s billing practices, it nonetheless could be reason

‐ ably inferred that he had acquired direct knowledge through

his employment. It also found that Bellevue “materially

added” to the publicly disclosed allegations with his personal

knowledge of specific instances in which Hartgrove was over

census.

After the district court’s decision, Bogina made clear that

the amended definition of “original source” controls. See

809 F.3d at 369. Therefore, Bellevue must show that he “has

knowledge that is independent of and materially adds to the

publicly disclosed allegations or transactions” and “has

voluntarily provided the information to the Government

before filing [its] action.” 31 U.S.C. § 3730(e)(4)(B) (2010). It is

undisputed that Bellevue voluntarily provided information

concerning his allegations to the government before filing suit.No. 15

‐ 3473 15

In order to possess “independent knowledge,” the relator

must “have learned of the allegation or transactions independ

‐ ently of the public disclosure.” Cause of Action

, 815 F.3d at 283

(citation omitted). As the district court noted, we have permit

‐

ted an inference of independent knowledge where the relator

had an opportunity to observe the contested conduct. See

Leveski

, 719 F.3d at 838; United States ex rel. Lamers v. City of

Green Bay

, 168 F.3d 1013, 1017 (7th Cir. 1999). However, we

need not decide whether Bellevue is entitled to such an

inference because he has not “materially add[ed]” to the

publicly disclosed allegations.

Bellevue recycles the district court’s analysis regarding

his material addition to the publicly disclosed allegations.

However, this line of reasoning was foreclosed by Cause of

Action

. In that case, we found that because the plaintiff’s

allegations were “substantially similar to” the publicly dis

‐

closed allegations, the plaintiff did not “materially add” to the

public disclosure and could not be an original source. 815 F.3d

at 283 (citation omitted). This conclusion applies with equal

force here, and Bellevue has not provided a reason to diverge

from it. Thus, we find that Bellevue is not an original source of

the allegations, and his FCA and IFCA claims are precluded by

the public

‐ disclosure bar.

III. CONCLUSION

The allegations in this case fall within the public

‐ disclosure

bar to the FCA, and, therefore, the district court properly

dismissed the amended complaint with prejudice. The judg

‐

ment of the district court is AFFIRMED.