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The Claims Court entered judgment in favor of Starry on its bid protest claim, concluding that the Department of Health and Human Services acted arbitrarily and capriciously in canceling its solicitation seeking to procure certain business operations services. The Claims Court thereafter awarded Starry attorney fees at the rates actually billed to Starry by its counsel, finding that the “extreme measures that [Starry] was forced to pursue to vindicate its right to a rational and lawful federal procurement process, combined with the shocking disregard of the truth by” HHS, constituted a “special factor” justifying an award of fees above the EAJA’s “default rate” of $125 per hour. EAJA, the Equal Access to Justice Act, 28 U.S.C. 2412(d)(2)(A), provides that when a trial court finds that a “special factor” exists, it is authorized to increase the statutory attorney fee rate in certain cases brought by or against the government. The Federal Circuit vacated the award, holding that the Claims Court erred as a matter of law in holding that an agency’s improper or dilatory conduct during the administrative process that gave rise to the litigation between the parties can constitute a “special factor.” EAJA does not contain any reference to prelitigation activities. View "Starry Associates, Inc. v. United States" on Justia Law

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The Supreme Court reversed the decision of the court of appeals declaring the City of Rochester’s competitive bidding process and the resulting contract awarded to First Transit invalid. The City owned a fleet of buses operated by First Transit, Inc. since 2012. Until 2012, those buses were operated by Rochester City Lines Company (RCL). In the instant case, RCL challenged the City’s competitive bidding process, which resulted in the bus operation contract being awarded to First Transit. The City’s appointed moderator rejected RCL’s protest. The court of appeals, however, ruled that the City’s request for proposals (RFP) appeared impermissibly biased against RCL. The Supreme Court reversed and remanded the case, holding that RCL forfeited any appearance-of-bias argument. View "Rochester City Lines Co. v. First Transit, Inc." on Justia Law

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A three-year “risk corridors” program described in the Patient Protection and Affordable Care Act, 42 U.S.C. 18001, implemented by the Department of Health and Human Services (HHS), was intended to promote participation in insurance exchanges. Participating insurers, whose costs of providing coverage exceeded the premiums received (using a statutory formula) were to be paid a share of their excess costs while participating plans whose premiums exceeded their costs would pay in a share of their profits. The program “permit[ted] issuers to lower [premiums] by not adding a risk premium" for uncertainties in the 2014-2016 markets. The actual total "payments in"were less than requested "payments out" and Congress prohibited HHS from using its appropriations for the program. Prorated payments were issued. The insurer filed suit. The Federal Circuit affirmed summary judgment in favor of the government. The statute created an obligation of the government to pay exchange participants the amount indicated by the statutory formula but riders in the FY 2015 and 2016 appropriations bills repealed or suspended the obligation to make payments out in an aggregate amount exceeding payments in. Congress made the policy choice to cap payments. No statement or action by the government evinced an intention to form a contract; the risk corridors program was simply an incentive program. Because there was no contract, the insurer’s “takings” claim also failed. View "Land of Lincoln Mutual Health Insurance Co. v. United States" on Justia Law

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A three-year “risk corridors” program described in the Patient Protection and Affordable Care Act, 42 U.S.C. 18001, implemented by the Department of Health and Human Services (HHS), was intended to promote participation in insurance exchanges. Participating insurers, whose costs of providing coverage exceeded the premiums received (using a statutory formula) were to be paid a share of their excess costs while participating plans whose premiums exceeded their costs would pay in a share of their profits. The program “permit[ted] issuers to lower [premiums] by not adding a risk premium" for uncertainties in the 2014-2016 markets. The actual total "payments in"were less than requested "payments out" and Congress prohibited HHS from using its appropriations for the program. Prorated payments were issued. Moda filed suit. The Claims Court granted Moda partial summary judgment as to liability, stipulated to be $209,830,445.79. Dozens of other insurers filed actions, with mixed results. The Federal Circuit reversed. The statute created an obligation of the government to pay exchange participants the amount indicated by the statutory formula but riders in the FY 2015 and 2016 appropriations bills repealed or suspended the obligation to make payments out in an aggregate amount exceeding payments in. Congress made the policy choice to cap payments. No statement by the government evinced an intention to form a contract; the statute, its regulations, and HHS’s conduct simply created an incentive program. View "Moda Health Plan, Inc. v. United States" on Justia Law

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The Supreme Court affirmed the judgment of the trial court entering judgment on the jury’s general verdict in favor of real-estate developers (Developers) and against the City of Rapid City in this suit seeking to recover the prospective cost of repairing roads in a development outside Rapid City. Specifically, the Court held that the circuit court did not err by (1) denying the City’s motion for summary judgment on the issue of liability; (2) excluding evidence of the Developers’ litigation and settlement with their subcontractors; (3) granting one of the developer’s motion for judgment as a matter of law; (4) instructing the jury on estoppel defenses; and (5) not instructing the jury on the City’s public-nuisance claim. View "City of Rapid City v. Big Sky, LLC" on Justia Law

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In this appeal arising from a construction contract dispute, the Supreme Court held (1) complete and strict performance is required for all construction contract terms relating to the design and construction itself, but ordinary contract principles, including the traditional Massachusetts materiality rule, apply to breaches of other provisions, such as the one at issue in this case governing payment certifications; and (2) as recovery sought under a theory of quantum meruit, good faith applies to the contract as a whole, and the intentional commission of breaches of individual contract provisions must be considered in the overall context. A superior court judge in this case concluded that Plaintiff was barred from seeking recovery on the contract or under quantum meruit because it intentionally filed false certifications of timely payments to subcontractors. It also concluded that Defendant could not maintain a fraud action against Plaintiff, in which it sought damages in addition to a payment Defendant had already withheld, because any recovery would be duplicative. The Supreme Judicial Court held (1) Plaintiff’s false certifications and intentional subcontractor payment delays constitute a material breach of the contract and precluded recovery for breach of contract; (2) disputed material facts precluded summary judgment on the quantum meruit claim; and (3) the dismissal of Defendant’s fraud claim against Plaintiff was error. View "G4S Technology LLC v. Massachusetts Technology Park Corp." on Justia Law

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Brookdale employed Prather to review Medicare claims before their submission for payment. Many of these claims were missing required certifications from physicians attesting to the need for the medical services provided. Certifications must “be obtained at the time the plan of care is established or as soon thereafter as possible.” 42 C.F.R. 424.22(a)(2).Prather filed a complaint under the False Claims Act, 31 U.S.C. 3729, alleging an implied false certification theory. The district court dismissed her complaint. The Sixth Circuit reversed in part, holding that Prather had pleaded two claims with the required particularity and that the claims submitted were false. On remand, the district court dismissed Prather's Third Amended Complaint in light of the Supreme Court’s 2016 clarification of the materiality element of an FCA claim. The Sixth Circuit reversed. Prather sufficiently alleged the required materiality element; the timing requirement in section 424.22(a)(2) is an express condition of payment and Prather alleges that the government paid the claims submitted by the defendants without knowledge of the non-compliance, making those payments irrelevant to the question of materiality. Section 424.22(a)(2) is a mechanism of fraud prevention, which the government has consistently emphasized in guidance regarding physician certifications and Prather adequately alleged “reckless disregard” of compliance and whether this requirement was material. View "Prather v. Brookdale Senior Living Community" on Justia Law

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Brookdale employed Prather to review Medicare claims before their submission for payment. Many of these claims were missing required certifications from physicians attesting to the need for the medical services provided. Certifications must “be obtained at the time the plan of care is established or as soon thereafter as possible.” 42 C.F.R. 424.22(a)(2).Prather filed a complaint under the False Claims Act, 31 U.S.C. 3729, alleging an implied false certification theory. The district court dismissed her complaint. The Sixth Circuit reversed in part, holding that Prather had pleaded two claims with the required particularity and that the claims submitted were false. On remand, the district court dismissed Prather's Third Amended Complaint in light of the Supreme Court’s 2016 clarification of the materiality element of an FCA claim. The Sixth Circuit reversed. Prather sufficiently alleged the required materiality element; the timing requirement in section 424.22(a)(2) is an express condition of payment and Prather alleges that the government paid the claims submitted by the defendants without knowledge of the non-compliance, making those payments irrelevant to the question of materiality. Section 424.22(a)(2) is a mechanism of fraud prevention, which the government has consistently emphasized in guidance regarding physician certifications and Prather adequately alleged “reckless disregard” of compliance and whether this requirement was material. View "Prather v. Brookdale Senior Living Community" on Justia Law

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As a school principal, Buendia took kickbacks from Shy. Detroit Public Schools (DPS) paid Shy for supplies he never delivered. Some of the money came from the federal government. The FBI searched Shy’s home and found a ledger of kickbacks Shy owed Buendia. Buendia was convicted of federal-programs bribery, 18 U.S.C. 666(a)(1)(B), and sentenced to 24 months’ imprisonment. The Sixth Circuit affirmed, rejecting her argument that the district court violated her constitutional right to present a complete defense when it excluded evidence of her kickback expenditures and the alleged receipts of expenditures for school purposes. The right to present a complete defense yields to reasonable evidentiary restrictions. The court correctly excluded as irrelevant evidence of how Buendia spent the kickback money and correctly excluded the receipts of school expenditures as hearsay. Regardless of how Buendia eventually spent the money, she “corruptly solicit[ed]” it because, by awarding contracts to Shy in exchange for kickbacks, she subverted the normal bidding process in a manner inconsistent with her duty to obtain goods and services for her school at the best value. Nor did the government open the door" by introducing testimony that Buendia bought massages using a gift card from Shy to show that she accepted kickbacks. View "United States v. Buendia" on Justia Law

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The VA sought bids for procurement of medical gases. Three bids were determined to be in the competitive range: RAS, Irish, and Progressive. Progressive won a bid protest in part. The Claims Court enjoined the VA from awarding the contracts to RAS and Irish, vacated the awards to those companies, and remanded the case to the VA. The VA filed a Motion, explaining its need to continuously supply medical gases and informed the court of its plan to award an emergency bridge. Without receiving a response from Progressive, the court stated that it “[did] not deem the proposed course of action to be non-compliant.” A series of motions followed, concerning Progressive’s “entitlement to compensation for the severe economic harm” and its deadline for seeking attorney fees and costs under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(2)(G). Later, the court denied Progressive’s request that it direct the VA to re-evaluate the bid proposals within the competitive range, rather than resolicit the contracts altogether. Meanwhile, the VA resolicited the contracts, applied the Rule of Two, and awarded contracts to RAS and Irish. The Federal Circuit affirmed. Progressive’s Rule 59(e) motion was untimely and the Claims Court did not abuse its discretion in denying Progressive’s 60(b)(6) motion. View "Progressive Industries, Inc. v. United States" on Justia Law