Opinion ID: 2746816
Heading Depth: 1
Heading Rank: 5

Heading: three counts in the complaint

Text: Based on these allegations, Mastej’s complaint brought three causes of action. Count I is the presentment count and alleges that the Defendants violated the FCA by knowingly presenting (i.e., submitting) false interim claim forms and false annual hospital cost reports to Medicare. See 31 U.S.C. § 3729(a)(1) (1994). Mastej contends that the interim claim forms and hospital cost reports were false because (1) they sought reimbursement for medical services that were not legally reimbursable at all by Medicare due to the Defendants’ Stark and Anti-kickback 12 The complaint alleges that the Defendants submitted the 2008 report on June 7, 2010 after they submitted the 2009 report on May 26, 2010. Whether this is the case or simply a scrivener’s error is unimportant to the issues presented on appeal. 19 Case: 13-11859 Date Filed: 10/30/2014 Page: 20 of 41 violations and (2) the annual hospital cost reports then certified the Defendants’ compliance with federal laws and regulations. Count II is the make-or-use count. It alleges that the Defendants “knowingly made, used, or caused to be made or used, false records or statements—i.e., the false express or implied certifications of compliance and representations made or caused to be made by Defendants when initially submitting the false claims for interim payments and the false certifications made or caused to be made by Defendant[s] in submitting the cost reports and Requests for Reimbursement—to get false or fraudulent claims paid or approved by the Government.” See 31 U.S.C. § 3729(a)(2) (1994). 13 Count III is the reverse-false-claim count. It alleges that the Defendants violated the FCA by knowingly making false statements on their interim claim forms and hospital cost reports in an effort to avoid repaying money owed to Medicare. See 31 U.S.C. § 3729(a)(7) (1994). Mastej contends that the 13 In 2009, Congress amended the FCA. See footnote 3, supra. Under the pre-amendment version, a “make or use” violation occurred when a person “knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Government.” 31 U.S.C. § 3729(a)(2) (1994) (emphasis added). After the 2009 amendment, a “make-or-use” violation occurs when a person “knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim.” 31 U.S.C. § 3729(a)(1)(B) (2009) (emphasis added). Mastej’s Count II allegations track the preamendment version. 20 Case: 13-11859 Date Filed: 10/30/2014 Page: 21 of 41 Defendants violated this provision because they knowingly prepared their false claims and reports to conceal or avoid their responsibility to repay Medicare for its payout of claims that were not legally reimbursable. 14