United States ex rel. Polukoff v St. Marks Hospital et al.

Polukoff appealed the dismissal of his qui tam claims for false Medicare claims for unnecessary heart procedures. The panel reversed and remanded. It held the district court erred in ruling medical judgment cannot be the basis for legally false claims as the False Claims Act is to be read broadly, opinions can be the basis of liability as can claims for medically unnecessary treatments and held the test for whether a treatment is unnecessary is the federal regulatory definition reasonable and necessary  set out in the Medicare Program integrity manual and here the complaint alleged facts such as a high number of the procedures, the violation of internal and industry guidelines, an internal investigation finding violations of policy, coding the procedures in a way to make them eligible for reimbursement and evidence that the hospital administration knew the claims for the procedures did not meet the federal standard were enough to survive the motions to dismiss here and further held the allegations met the specificity requirement of Rule of Civil Procedure 9.

Canyon Fuel Company v Secretary of Labor; Federal Mine Safety and Health Review Commission

Canyon sought review of Commission’s affirmation by equal division of the administrative law judge decision that Canyon violated 30 CFR 75.380(d)(5). The panel reversed and vacated the citation. It first held that 75.380(d)(5) is ambiguous as to whether conditions outside the mine in question can be considered in determining if an escape route is suitable, the Secretary’s interpretation that allows consideration of conditions outside the mine is consistent with the intent as of the promulgation of the original regulation on the matter and is consistent with the objective of the mine safety act and thus the panel deferred to secretary’s interpretation under the Chevron doctrine. However, it held the administrative law judge’s ruling was not supported by substantial evidence because the Secretary failed to provide evidence from which a comprehensive comparison between the current alternate escape route and the proposed escape route could be made and absent the comparison the current route cannot be deemed unsuitable.

Warnick v Cooley et al.

Warnick appealed dismissal of his federal state claims for malicious prosecution and other torts with prejudice. The panel affirmed. It held Cooley and the other prosecutors were absolutely iinue as to claims arising form charging Warnick with crimes, that Warnick failed to plausibly plead the other claims against Cooley and the other defendants as he failed to identify any false settlements and whether those statements were used in the investigation, that Warnick waived his conspiracy claim argument, all Warrick’s arguments about his state law claims were forfeited as they were not made in his opening brief, and found no error in denying leave to further amend as Warnick did not file a proper motion or identify how the problems with his amend complaint would be remedied.

United States v Garcia-Herrera

Garcia-Herrera appealed the denial of part of his motion for his case file from his criminal case attorney. The panel dismissed the appeal and vacated the district court order holding 28 USC 3231 did not grant the district court subject matter jurisdiction over the motion.