U.S. ex rel. Fischer v. Cmty. Health Network, Inc.
U.S. ex rel. Fischer v. Cmty. Health Network, Inc.
2024 WL 1773655 (S.D. Ind. 2024)
April 10, 2024
Klump, M. Kendra, United States Magistrate Judge
Summary
The court ordered CHOP to comply with the relator's request for production and depositions regarding information related to CHOP's ownership and compensation practices, finding that the requested information was relevant to the case and proportional to the needs of the case. The court also determined that the existing protective order was sufficient to safeguard CHOP's proprietary information.
Additional Decisions
UNITED STATES OF AMERICA ex rel. Thomas P. Fischer, et al., Plaintiffs,
v.
COMMUNITY HEALTH NETWORK, INC., et al., Defendants
v.
COMMUNITY HEALTH NETWORK, INC., et al., Defendants
No. 1:14-cv-01215-RLY-MKK
United States District Court, S.D. Indiana, Indianapolis Division
Filed April 10, 2024
Klump, M. Kendra, United States Magistrate Judge
ORDER
*1 This matter is before the Court on Relator Thomas P. Fischer's Motion to Compel Document Production and Testimony from Non-Parties Community Hospitals Oncology Physicians, LLC, (“CHOP”) and Sumeet Bhatia, M.D. (“Dr. Bhatia”), Dkt. [711], and Non-Parties CHOP and Dr. Bhatia's Motion to Quash or Alternatively Motion for Protective Order, Dkt. [731]. These motions are fully briefed and ripe for the Court's decision.
I. Background
A. Relator's Qui Tam Complaint
On July 21, 2014, Relator filed a qui tam complaint, alleging that the Defendant Community Health Network Inc. (“CHN”) and others violated the federal False Claims Act (“FCA”) and the Indiana False Claims and Whistleblower Protection Act. (Dkt. 1). Relator also brought a breach of contract and other state law claims relating to his employment at CHN. (Id.; see also Dkt. 32 (1st Amend. Compl.)).
Five years later, on August 7, 2019, the United States elected to intervene in part and declined to intervene in part, and this matter was unsealed on December 23, 2019. (Dkts. 86, 93). On January 6, 2020, the United States filed its Amended Complaint in Intervention against CHN. (Dkt. 96).
On December 2, 2020, Relator filed his Second Amended Complaint against CHN and others (collectively, “Defendants”).[1] (Dkt. 134). As set forth in his Statement of Claims, Relator asserts that Defendants violated the federal and state False Claims Acts by submitting claims to Medicare and Medicaid “that were false because they resulted from violations of the Stark Law ... and the Anti-Kickback Statute” (“AKS”). (Dkt. 496 at 1-2). Relator alleges that “CHN improperly incentivized and induced employed physicians and affiliates to secure their referrals” by means of several different “payments and business relationships” that violated the law. (Id. at 6). As relevant here, Relator alleges that “CHN violated AKS and Stark by paying above fair market rates to ... CHOP, a group of medical oncologists, to induce them to practice exclusively at CHN and to secure oncology referrals and ancillary services.” (Id. at 8). Defendants deny these claims. (Dkt. 497 at 7).
B. Discovery Dispute
In pursuit of his CHOP claims, Relator served Rule 45 document subpoenas on CHOP and Dr. Bhatia in October 2022. (Dkts. 732-1, 732-2). CHOP “provides oncological care via an exclusive arrangement with” CHN and is owned by four physicians, one of whom is Dr. Bhatia. (Dkt. 732-3 at 1). Relator also subpoenaed various CHOP representatives, including Dr. Bhatia, to testify at depositions. (Dkt. 771 at 7). As relevant here, Relator's Request for Production (“RFP”) #7 to both CHOP and Dr. Bhatia seeks information regarding CHOP's ownership structure and provider compensation. (Dkt. 732-1 at 8; Dkt. 732-2 at 8-9).
*2 In December 2022, CHOP and Dr. Bhatia[2] objected to Relator's subpoena on a variety of grounds. (Dkt. 712-1 at 3 (overly broad; unduly burdensome; irrelevant to Relator's claims; disproportionate to the needs of the case); Dkt. 712-2 at 5 (overly broad; unduly burdensome)). CHOP refused to produce any documents in response to RFP #7, (Dkt. 712-1 at 3)[3], while Dr. Bhatia agreed to make a limited production of his personal records and email accounts, (see Dkt. 712-2 at 5). As evidenced by subsequent meet and confers and correspondence, the debate quickly became focused on the relevancy and confidentiality of the sought information. (See, e.g., Dkt. 712-3 at 3 (12/8/2022 email from CHOP to Relator: “Could you please further explain Relator's position on the relevance and discoverability of this information with citations to the relevant provision of the Stark Law?”); Dkt. 712-4 at 4 (2/21/2023 letter from CHOP to Relator: “Relator's request for such irrelevant information is all the more unreasonable given that it is directed towards a non-party to the litigation; attempts to obtain commercially-sensitive, competitive information that is confidential and proprietary to CHOP; and invades the privacy of the individual physicians who are likewise not parties to the litigation....”); Dkt. 712-5 at 2 (3/10/2023 email from CHOP to Relator: “Dr. Bhatia and CHOP have objected to providing documents responsive to Request No. 7. CHOP views this information as confidential and trade secret information that is irrelevant to Relator's claims against [CHN].”)).
No forward progress was made and, on December 22, 2023, more than a year after the subpoenas were served, Relator filed the Motion to Compel now before the Court, seeking to compel CHOP and Dr. Bhatia to produce documents responsive to RFP #7 and provide corresponding deposition testimony. (Dkts. 711, 712). CHOP then filed a Motion to Quash or, Alternatively, Motion for Protective Order. (Dkts. 731, 732). Responses[4] and replies followed, (Dkts. 726, 732, 735, 736, 747, 749), and Relator was granted permission to file a sur-reply to the Motion to Quash, (Dkts. 756, 768). The Court also heard argument on the dueling motions at a February 12, 2024, telephonic hearing, at which Relator, CHOP, and CHN were all represented. (Dkt. 752). The Motion to Compel and Motion to Quash are now ripe for the Court's decision.
II. Legal Standard
A. Rules 26, 30, and 34
Federal Rule of Civil Procedure 26 allows a party to “obtain discovery regarding any nonprivileged matter that is relevant to any party's claim or defense and proportional to the needs of the case.” Fed. R. Civ. P. 26(b)(1). Proportionality is assessed by “considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to the information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit.” Id.
Within the scope of Rule 26(b), a party may compel production of documents from a non-party consistent with the restrictions of Rule 45. Fed. R. Civ. P. 34(c). A party may seek to “depose any person, including a party, without leave of court except as provided in Rule 30(a)(2),” and compel the deponent's attendance “by subpoena under Rule 45.” Fed. R. Civ. P. 30(a)(1).
B. Rule 45
With certain limitations, Rule 45 allows a party to command (a) production of documents or electronically stored information in a non-party's possession, custody, or control or (b) the non-party's attendance at a deposition. Fed. R. Civ. P. 45. The served party may object to production by serving the party or attorney named on the subpoena with a written objection no later than 14 days after the subpoena is served. Fed. R. Civ. P. 45(d)(2)(B). In response to the objection(s), the serving party “may move the court for the district where compliance is required for an order compelling production.” Fed. R. Civ. P. 45(d)(2)(B)(i). The served party may also move to quash a subpoena if he or she believes it runs afoul of the Rule. Fed. R. Civ. P. 45(d)(3).
III. Discussion
*3 In disputed RFP #7, Relator seeks information about CHOP's ownership structure and the compensation of CHOP physicians. More specifically, Relator requests to compel production of:
All documents relating to, concerning, and/or showing all CHOP payments to physicians, Nurse Practitioners and Physician Assistants, including, but not limited to:
a. the agreements, partnership agreements, employment agreements, investment agreements, etc. for this group of providers;
b. all documents reflecting how payments were/are calculated for this group of providers;
c. all documents reflecting how payments were/are documented or memorialized for this group of providers; and
d. all documents reflecting the amounts actually paid to this group of providers.
(Dkt. 732-1 at 8). CHOP objects to the production, arguing the request is irrelevant to Relator's claims, overly broad, unduly burdensome, and disproportional to the needs of the case. (Dkt. 712-1 at 3; Dkt. 732 at 12-13, 16-20). In addition, CHOP objects on the grounds that the information is highly confidential and trade secret.[5] (Dkt. 732 at 14-15, 20).
A. Relevancy
At its core, this dispute revolves around the relevancy and confidentiality or secrecy of the requested information. The Court will begin with the former, as relevancy acts as a gatekeeper to any discovery request. To assess relevancy, the Court must review the claims and defenses at issue. See Fed. R. Civ. P. 26(b)(1) (“Parties may obtain discovery regarding any nonprivileged matter that is relevant to any party's claim or defense and proportional to the needs of the case....”); Chavez v. DaimlerChrysler Corp., 206 F.R.D. 615, 619 (S.D. Ind. 2002) (“For the purpose of discovery, relevancy will be construed broadly to encompass ‘any matter that bears on, or that reasonably could lead to other matter that could bear on, any issue that is or may be in the case.’ ”) (citations omitted).
i. Regulatory Background
Although the parties and CHOP disagree as to the merits of Relator's case, their briefs evidence an agreement as to the basic elements of his claims. These basic elements, articulated in terms of the entities at issue (i.e., CHOP, CHN, and CHN-affiliates), are as follows:[6]
(1) a CHOP physician referred a health service[7] to CHN or a CHN-affiliate (the health service provider);
(2) the physician had a “financial relationship” with the health service provider; and
(3) the health service provider submitted claims to Medicare for the referred health service.
(Dkt. 712 at 8, 9; Dkt. 726 at 2; see also Dkt. 732 at 13 (“join[ing] CHN's arguments on the subpoenas’ irrelevancy”)). Once Relator makes a prima facie showing as to these elements, the burden shifts to the defendant to show that the financial relationship meets an applicable exception under the regulatory scheme. (Dkt. 712 at 9; Dkt. 726 at 2). The parties agree as to these elements. As is so often the case, however, the proverbial devil is in the details. The present dispute requires a deep dive into the second element—the existence of a financial relationship between CHOP physicians and CHN.[8] To show the requisite “financial relationship” between the referring physician and CHN, Relator must establish that the physician had either (a) an ownership or investment interest in CHN or (b) a “compensation arrangement” with CHN. (Dkt. 712 at 8 (citing 42 U.S.C. § 1395nn(a)(2)); Dkt. 726 at 2).
*4 With no one suggesting that the CHOP doctors own or invest in CHN, Relator is pursuing the existence of a compensation arrangement to prove the requisite financial relationship. So, descending even deeper into the regulatory pool, one learns that a “compensation arrangement” is one that involves renumeration – either direct or indirect – between the physician and CHN. (Dkt. 712 at 8 (citing 42 C.F.R. § 411.354(c)); Dkt. 726 at 2). Here too, the parties (and CHOP) appear to agree on the key definitions, although they dispute their ultimate significance and application.
Renumeration is direct if it passes between the referring physician and CHN without any intervening persons or entities. (Dkt. 712 at 9 (citing 42 C.F.R. § 411.354(c)(1)(i)); Dkt. 726 at 2-3 (citing same section)). When the only intervening entity is a physician organization in which the physician has an ownership or investment interest, that physician is said to “stand in the shoes” of his or her physician organization, and he or she is treated as having a direct compensation arrangement with CHN. (Dkt. 712 at 9 (citing 42 C.F.R. § 411.354(c)(1)(ii)); Dkt. 726 at 3 (citing same section)). A non-owner physician may elect to stand in the shoes of his or her organization. (Dkt. 712 at 9 (citing 42 C.F.R. § 411.354(c)(1)(ii)); Dkt. 726 at 3 n.3 (citing 42 C.F.R. § 411.354(c)(3)(iii))).
On the other hand, an indirect compensation arrangement exists if: (1) an unbroken chain of persons or entities that have financial relationships link the referring physician to CHN; (2) the physician receives aggregate compensation[9] from CHOP that varies with (or takes into account) the volume or value of referrals or other business generated for CHN; and (3) CHN knew, recklessly disregarded, or deliberately ignored that the physician's compensation varied with the volume or value of referrals or other business generated by the referring physician. (Dkt. 712 at 9-10 (citing 42 C.F.R. § 411.354(c)(2)(i)-(iii)); Dkt. 726 at 5-6 (citing 42 C.F.R. § 411.354(c)(2))).
With this background in mind, the Court now proceeds to the question at hand: is the information Relator seeking relevant to his claims? Or, in the present context, does the information have any bearing on the existence of a “compensation arrangement” between CHOP physicians and CHN?
ii. Direct Compensation
As set forth above, proving a compensation arrangement requires proving either direct or indirect compensation. The Court begins by considering whether RFP #7 seeks information relevant to the existence of direct compensation. CHOP “provides oncological care via an exclusive arrangement with” CHN and is owned by four physicians (one of whom is Dr. Bhatia). (Dkt. 732-3 at 1). At a minimum, therefore, it appears that those four physician-owners would “stand in the shoes” of CHOP under the regulatory framework at issue here. (See Dkt. 732 at 13 (“under the Stark Law, CHOP's physician owners ‘stand in the shoes’ of CHOP, thus creating a direct contractual relationship between CHOP and CHN”)). Because CHOP and CHN have a contractual relationship involving direct renumeration, (see Dkt. 726 at 3 (“CHOP contracts with, and CHOP as a group is compensated by, Community”)), it seems to follow that the CHOP physician-owners, standing in the shoes of CHOP, have a direct compensation arrangement with CHN as well.
*5 If the parties agreed to all these facts, the present dispute might be resolved or, at a minimum, streamlined. No such luck. While CHN does not seem to contest this stand-in-the-shoes analysis with any vehemency,[10] CHN has explicitly stated that it is not stipulating to the existence of a direct compensation arrangement between CHOP doctors and CHN. Therefore, without going further, the Court is convinced that Relator has shown the relevancy of at least that portion of RFP #7 which seeks information regarding the ownership structure for CHOP. (See, e.g., Dkt. 732-1 at 8 (“... partnership agreements, employment agreements, investment agreements, etc. for this group of providers ...”)). The ownership information is necessary to show that the CHOP physician-owners stand in the shoes of CHOP and therefore have a direct compensation arrangement with CHN. To reiterate, the Court notes that no one seems to be arguing anything to the contrary. Indeed, CHOP (a non-party) appears to agree that its owners stand in its shoes and therefore have a direct compensation arrangement with CHN.[11] But as also noted, CHN has not stipulated to this fact and, absent a stipulation, a party must pursue the information necessary to prove its case. As such, the Court concludes that the ownership information sought by Relator in RFP #7 is relevant to the issue of direct compensation.
iii. Indirect Compensation
CHN and CHOP indicate that the Court's relevancy inquiry should stop here. First, they argue that because Relator can prove his claims using a “direct compensation” theory, he should not be permitted to seek information relating to an “indirect compensation” theory.[12] This argument pertains more to proportionality than relevancy, the suggestion being that because Relator has the information he needs under a direct compensation theory, the additional probative value of indirect compensation information is vastly outweighed by the burden of production. The Court finds this argument unpersuasive. CHN has not stipulated to a direct compensation arrangement with the CHOP physicians, making Relator's pursuit of an alternative theory of liability a reasonable course of action.[13] (See Dkt. 726 at 5 (acknowledging that “[i]f an individual CHOP physician is not deemed, or does not elect, to ‘stand in the shoes’ of CHOP, Relator must demonstrate than an indirect compensation arrangement exists between a referring CHOP physician and a DHS entity to satisfy his initial burden of proving a financial relationship under the Stark Law exists.”) (emphasis in original)). The Court therefore proceeds to consider the relevancy of indirect compensation information, i.e., how individual CHOP physicians are compensated.
*6 In its second attack on Relator's request for indirect renumeration data, CHN argues that Relator cannot prove the third element of an indirect compensation arrangement: that CHN knew, recklessly disregarded, or deliberately ignored that the physician's compensation varied with the volume or value of referrals. (Dkt. 726 at 7). As CHN sees it, because Relator will never be able to prove this requisite knowledge, Relator is not entitled to obtain information about the first and second prongs, i.e., how the individual physician's compensation is calculated. (Id.). CHOP repeats this argument, emphasizing that Relator had 10 years to develop this information but has come up empty handed. (Dkt. 732 at 3).
Despite nearly 10 years having passed since this case was filed, it remains in the discovery stage. And at that stage, adopting the approach for which CHN and CHOP advocate would be the wrong call. Relator may have work to do on proving the third prong of his indirect compensation arrangement theory.[14] But at this juncture in the case, the Court will not assume that he will never be able to do so. Indeed, the point of discovery is to find out just this type of information. Key depositions have yet to be held. And, it's worth noting, much of the parties’ discovery efforts to date have focused on other topics. (See, e.g., Dkts. 512, 624, 640). Relator may unearth evidence relating to the third prong (i.e., knowledge, reckless disregard, or deliberate ignorance). Although CHN and CHOP argue that he will never succeed, the Court will not preclude him from trying. See Prince v. Kato, No. 18 C 2952, 2020 WL 1874099, at *4 (N.D. Ill. Apr. 15, 2020) (“Even though the 2015 Amendments to the Federal Rules of Civil Procedure were designed to reduce the amount of unnecessary and excessive discovery that often take place, they were not designed to foreclose parties from proving their claims. Discovery is still just that—the opportunity to discover whether evidence will support or disprove a claim.”) (emphasis in original); Signature Transp. Grp., LLC v. Jacobs, Case No. 18 C 6896, 2020 WL 1663124, at *3 (N.D. Ill. Apr. 3, 2020) (“The Court cannot say with the same confidence expressed by Defendants that Plaintiffs cannot obtain through discovery facts to prove all or some of their claims. At this point, Plaintiffs have a legal theory and Defendants have a legal theory; it will take some discovery to see which side's legal theory will prevail once all the relevant facts are adduced.”). In drawing this conclusion, the Court recognizes that this case is far from its infancy. But, as noted, much of the parties’ discovery efforts have focused on issues distinct from the one at hand; nor is there any indication that the Relator has been dilatory in his efforts to prosecute his case.
In conclusion, the Court finds that the compensation information sought by Relator in RFP #7 is relevant to the issue of indirect compensation.
B. Proportionality: Burden & Expense
The Court now turns to the question of whether the discovery request is proportional to the needs of the case. Proportionality is assessed by “considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to the information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit.” Fed. R. Civ. P. 26(b)(1).
*7 In this context, non-parties receive greater protections than parties. Rule 45 imposes a duty on the serving party to “take reasonable steps to avoid imposing undue burden or expense” on the non-party. Fed. R. Civ. P. 45(d)(1); see also Fed. R. Civ. P. 45(d)(3)(A)(iv) (“On timely motion, the court for the district where compliance is required must quash or modify a subpoena that ... subjects a person to undue burden.”). “Whether a subpoena imposes an ‘undue burden’ ... is a case specific inquiry that turns on such factors as relevance, the need of the party for the documents, the breadth of the document request, the time period covered by it, the particularity with which the documents are described and the burden imposed.” Charles v. Quality Carriers, Inc., No. 1:08-cv-00428-RLY-JMS, 2010 WL 396356, at *1 (S.D. Ind. Jan. 28, 2010) (citations omitted).
Considering these factors against the backdrop of this complex case, the Court concludes that Relator's request is proportional to the needs of the case and does not impose an undue burden on CHOP. As described above, the information sought by Relator is critical to his ability to prove certain aspects of his claims, which relate to important issues of public interest; indeed, without it, Relator would likely be precluded from pursuing certain theory(ies) of liability. Nor does Relator have any alternative source of the information, as evidenced by CHOP's own brief. The amount in controversy is significant. The question then becomes whether, considering the breadth and extent of the request, the burden or expense of production overwhelms the discovery's likely benefit to Relator.
In the present context, the burden of production consists of not only financial costs but also “the competitive harm of disclosure.” (Dkt. 732 at 4). The Court begins with production costs and then turns to the alleged harms relating to confidentiality.
To be sure, the financial burden on CHOP to comply with Relator's subpoena is not negligible. CHOP estimates that at a minimum, it will take it a total of 310 hours to collect and review the “at least 15,000 potentially responsive documents” and redact responsive material. (Dkt. 732 at 4; see also id. at 9-10). That burden, it argues, will fall primarily on Ms. Holman, CHOP's CEO. (Id. at 9). No one other than the CEO can perform this work, CHOP maintains, because of the “highly confidential” nature of the requested information. (Id.). “Based on Ms. Holman's salary and benefits, on a pro-rated basis, the direct opportunity cost to CHOP would be at least $31,000.” (Id. at 10; see also Dkt. 732-3 at 2-3). Although these production costs[15] are significant, the Court does not find that they impose an undue burden in the present context. These costs pale in comparison to the amount at stake in this case.
To the extent CHOP argues RFP #7 is overbroad and therefore imposes an undue burden for that reason, (Dkt. 732 at 18, 21), CHOP essentially abandoned that argument by focusing its efforts on relevancy and confidentiality objections when communicating with Relator. Had CHOP been willing to produce some material, albeit more limited in scope (time, type of document, etc.), it could have articulated as much to Relator during the multiple rounds of correspondence. It did not, and the Court does not now blame Relator for not expending energy on refining a request to which CHOP was objecting in its entirety. But even putting that aside, RFP #7 is not overbroad on its face. For example, although it covers a lengthy time period, (Dkt. 732-2 at 4 (“2008 through the present”)), the request reasonably corresponds to the timeframe alleged in Relator's Second Amended Complaint, (see Dkt. 134 at 54-62).
*8 In sum, the Court finds that RFP #7 and the depositions at issue are proportional to the needs of the present case. Moreover, they are not overbroad[16] and do not impose an undue burden or expense on CHOP.
C. Secrecy
The second component of CHOP's burden argument relates to the confidential or trade-secret nature of the sought information.[17] If a subpoena requires “disclosing a trade secret or other confidential ... information,” the reviewing court “may, on motion, quash or modify the subpoena.” Fed. R. Civ. P. 45(d)(3)(B)(i). Alternatively, a court may order production “under specified conditions if the serving party: (i) shows a substantial need for the testimony or material that cannot be otherwise met without undue hardship; and (ii) ensures that the subpoenaed person will be reasonably compensated.” Fed. R. Civ. P. 45(d)(3)(C). If a trade secret must be disclosed, Rule 26(c) allows for an order “requiring that a trade secret or other confidential research, development, or commercial information ... be revealed only in a specified way.” Fed. R. Civ. P. 26(c)(1)(G).
Protecting trade secrets is of paramount importance, but information merely being labeled a trade secret does not form a sufficient basis for barring disclosure of the requested information. Gotham Holdings, LP v. Health Grades, Inc., 580 F.3d 664, 665 (7th Cir. 2009). “[W]hen discovery is sought of trade secrets or confidential commercial information, the discovering party should be required to show that the discovery has sufficient relevancy and materiality to the case to outweigh whatever harm disclosure would cause.” Clark Floyd Landfill, LLC v. County of Clark, Ind., No. 4:18-cv-00004-RLY-DML, 2019 WL 7598147, at *4 (S.D. Ind. Sept. 26, 2019). This showing includes consideration of all relevant circumstances, such as “dangers of abuse, good faith, and availability of other means of proof.” Wright & Miller, 8A Fed. Prac. & Proc. Civ. § 2043 (3d ed.). If the requesting party shows relevancy and materiality, protective orders that direct the use and dissemination of the material are sufficient safeguards to lessen (or eliminate) any harm disclosure may cause. See id. (“In most cases the key issue is not whether the [trade secret or confidential commercial] information will be disclosed, but under what conditions, as the Supreme Court has recognized. The need for the information is ordinarily held paramount but reasonable protective measures are supplied to minimize the effect on the party making the disclosure.”).
The Court returns to the case at hand. In opposing Relator's request, CHOP submits:
CHOP's compensation information is treated as secret because it provides CHOP with a competitive edge in contract negotiations with CHN.... If CHN's counsel is able to ascertain CHOP's internal compensation and related financial decisions through this litigation, it would give CHN a competitive advantage in contract negotiations with CHOP in perpetuity going forward. This is an outcome that CHOP has worked to prevent from its outset.
*9 (Dkt. 732-3 at 5). CHOP details its efforts to maintain the confidentiality of the information sought in RFP #7 which “encompasses some of CHOP's most sensitive financial information,” (Dkt. 732 at 14). Access to compensation information is limited to CHOP's owners, accounting firm, and CEO (Ms. Holman). (Id.). “[A]ll hard copies of partnership, investment, and employment agreements (which include the specific compensation arrangements) are locked in a fire-proof safe, and only Ms. Holman and two equity partners have access.” (Id.). And, “for the past several years,” CHOP has required physician and nurse practitioners to sign nondisclosure agreements prohibiting disclosure of compensation information.[18] (Id. at 14-15).
Against this backdrop, CHOP argues that Relator “has not shown any need—no less a substantial one—for the irrelevant documents [he] seeks.” (Id. at 16). Relator responds that CHOP's trade secrecy concerns are overcome by the interests of disclosure and that the existing Protective Order would provide ample protection for CHOP's proprietary information. (Dkt. 712 at 14-15).
The Court finds CHOP's argument unpersuasive. As set forth above, Relator has shown that the material is highly relevant to this case and that without it, at least one of his theories of liability would likely collapse out of the gate. Moreover, Relator has no alternative source for the ownership and compensation information. As CHOP repeatedly points out, it keeps close hold of this data, and there does not appear to be an alternative source.[19]
Moreover, there is reason to question the magnitude of harm that would result from a protected disclosure. In his Reply in Support of [his] Motion to Compel, Relator points out that “CHOP has already produced some of the information that it now claims is so sensitive that the [ ] Protective Order ... is insufficient to safeguard it.” (Dkt. 736 at 3). Relator attached to his brief, under seal, “a document that CHOP produced in this litigation,” (Dkt. 737 (filed under seal)), that “appears to provide extensive detail regarding CHOP's compensation methodologies and related information, including W-2 compensation broken down by provider, dividends paid to each partner/owner, and the percentage of each partner/owners’ equity stake.” (Dkt. 736 at 3 (citations removed)). CHOP designated the document as “Attorneys’ Eyes Only.” (Id. at 3-4). In response, CHOP argues that its prior production “changes nothing” because the disclosed document was “irrelevant to whether the compensation that CHN paid to CHOP was fair market value.” (Dkt. 749 at 6).
CHOP's argument that the prior production “changes nothing” falls flat. The document may indeed be “irrelevant” to whether CHN paid CHOP fair market value (the Court declines to answer that question), but that does not end the discussion. The document unquestionably reveals “CHOP's 2017/2018 pay information by CHOP to its physicians, nurse practitioners, and employees,” (id.), and thus comprises information that is both responsive to RFP #7 and allegedly carefully guarded by CHOP senior management. The Court recognizes that CHOP's counsel “clawed-back the specific compensation information” “shortly after Relator filed his opposition to the Motion to Quash,” (id.), but this does not change the fact that the information was disclosed for approximately a year, (Dkt. 768 at 1), without apparent disaster.
*10 CHOP explains that the production was inadvertent and that the sensitive information “was buried within three pages of a 70 page document.” (Dkt. 749 at 6-7). In a different context, this explanation might be reasonable. Here, however, it seems somewhat lacking. CHOP has gone to great lengths to describe the walls and barriers erected around the compensation information. Surely the gatekeepers such as Ms. Holman would be cognizant of, and guard against, its disclosure, whether in 3 or 30 pages of a 70-page document. Regardless, the information was disclosed for over a year and no catastrophe ensued. As far as the Court is aware, CHOP continues its business.
In sum, while the Court concludes that the discovery requests at issue will require the disclosure of trade secret or other confidential information, the Court finds that said disclosure does not impose an undue burden on CHOP and that Relator has shown a substantial need for the material that cannot be otherwise met. Furthermore, there are adequate safeguards in place to protect CHOP's trade secrets and/or confidential information.[20] For example, CHOP may designate the information for “Attorneys’ Eyes Only.” (See Dkt. 214). The parties may also seal the information to protect it from public disclosure, as they have already done.[21] The Court therefore orders CHOP and Dr. Bhatia to comply with the subpoenas and produce any responsive material in accordance with the procedures set forth in the Protective Order issued in this case, (Dkt. 214). The Court further orders that Relator shall compensate CHOP and Dr. Bhatia for any reasonable costs incurred in producing responsive trade secret or confidential material.
IV. Conclusion
For the foregoing reasons, Relator's Motion to Compel Production of Documents and Testimony from Non-Parties CHOP and Sumeet Bhatia, M.D., Dkt. [711], is GRANTED. CHOP and Dr. Bhatia must provide material responsive to RFP #7 within 28 days of this Order.
For the foregoing reasons, Nonparties CHOP and Sumeet Bhatia's Motion to Quash, or, Alternatively, Motion for Protective Order, Dkt. [731], is DENIED IN PART and GRANTED IN PART. The Court DENIES CHOP and Dr. Bhatia's request to quash the subpoenas. The Court also DENIES CHOP and Dr. Bhatia's request for a protective order prohibiting deposition questions to CHOP, Dr. Bhatia, and CHOP representatives and/or employees regarding compensation. The Court GRANTS CHOP and Dr. Bhatia's motion for a protective order in that the Court ORDERS Relator to reimburse CHOP for reasonable costs CHOP incurs in producing material responsive to RFP #7 that constitutes “a trade secret or other confidential research, development, or commercial information.”
Any motion to amend the existing Protective Order, Dkt. 214, must be filed within seven days of this Order.
So ORDERED.
Footnotes
Community Health Network, Inc., Community Health Network Foundation, Inc., Community Physicians of Indiana, Inc., Visionary Enterprises, Inc., North Campus Surgery Center, LLC, South Campus Surgery Center, LLC, East Campus Surgery Center, Hamilton Surgery Center, LLC, Howard Community Surgery Center, Northwest Surgery Center, LLC, Hancock Surgery Center, Indianapolis Endoscopy Center, LLP, Community Endoscopy Center, LLC, and North Campus Office Associates, L.P.
CHOP and Dr. Bhatia filed a joint opposition to Relator's Motion to Compel. (Dkt. 732). As such, unless otherwise specified, the Court will refer to CHOP and Dr. Bhatia collectively as “CHOP” when discussing positions taken in the present dispute.
It appears CHOP produced documents in response to other requests in the subpoena. Relator asserts that “[a] number of those documents were also responsive to Request No. 7.” (Dkt. 747 at 3 n.3).
CHN also responded to Relator's Motion to Compel. (Dkt. 726). Relator urges the Court to “disregard” CHN's response because Relator's motion was “not directed at CHN.” (Dkt. 735 at 1). Given the importance of the issue of relevancy, see infra, the Court finds it appropriate to consider CHN's response.
Relator argues that CHOP waived its trade secret and undue burden objections. (Dkt. 747 at 2-3). The Court declines to find waiver and will address the substance of each objection.
The Court's analysis is limited to the discovery dispute at hand and its summary of the elements is just that, a summary. To the extent the parties dispute the finer details of the elements of the claims or defenses and how the relevant statutes intertwine, (compare, e.g., Dkt. 712 at 8 (“The Stark Law does not have a scienter requirement—it is a strict liability statute ....”), with Dkt. 726 at 2 n.1 (“There are additional elements of proof, including materiality and scienter, that are required for Relator to prove a False Claims Act violation ....”); see also Dkt. 496 at 2-6, 8-10 (statement of claims); Dkt. 497 at 8 (statement of defenses)), said disputes will be decided in due course. The Court need not do so at this juncture. In addition, the Court's abbreviated description of the elements should not read as a determination that CHN is a designated health services entity, a fact which CHN has not conceded, (Dkt. 726 at 5), and which is not at issue here.
The exact type or nature of health services is not at issue here. As such, for simplicity's sake, the Court will use the term “health service.”
For the reader's convenience, the Court will refer simply to CHN (as opposed to CHN and/or a CHN-affiliate) when discussing the elements going forward.
CHN includes an additional sub-element that Relator “must establish,” (Dkt. 726 at 5): “The amount of compensation that the CHOP physician receives from CHOP:
i. Is not [fair market value] for items or services actually provided; or
ii. Could increase as the number or value of the physician's referrals to the entity furnishing DHS increases, or could decrease as the number or value of the physician's referrals to the entity decreases; or
iii. Could increase as the amount or value of the other business generated by the physician for the entity furnishing DHS increases, or could decrease as the amount or value of the other business generated by the physician for the entity furnishing DHS decreases; or iv.
iv. Is payment for the lease of office space or equipment or for the use of premises or equipment.”
(Id. at 6 (citing 42 C.F.R. § 411.354(c)(2); see also Dkt. 712 at 10-11, 12 (Relator's discussion of CHN's “affirmative defenses”)). Because characterizing this analytical prong as an element versus an affirmative defense does not change the Court's ultimate decision regarding the Motions now before it, the Court will not discuss this portion of the regulation further.
See, e.g., Dkt. 726 at 3 (“CHOP is an intervening entity in the chain of compensation between the CHOP physicians who refer DHS and the DHS entity (in this case, solely for the purposes of this response, we assume Community is a DHS entity). ‘Stand in the shoes’ may move a CHOP physician-owner into CHOP's place in the chain of compensation....”) (emphasis added).
See Dkt. 732 at 13 (“under the Stark law, CHOP's physician owners ‘stand in the shoes’ of CHOP, thus creating a direct contractual relationship between CHOP and CHN.”); but see id. (referencing “the lack of any direct compensation arrangement between CHOP and CHN”)).
See Dkt. 726 at 1 (“Relator ... can satisfy [his] burden[ ] under the Stark Law without the information Relator seeks from CHOP and Dr. Bhatia. As a result, the information sought ... is irrelevant to the issues in this litigation.”); id. at 4 (“If there is a direct compensation arrangement between the CHOP physician group and Community, the compensation paid by Community to the CHOP group practice is the relevant arrangement to be analyzed for the applicable exceptions.... Compensation by CHOP at the individual physician level is irrelevant to either Relator's or Community's burdens of proof.”) (emphasis added); Dkt. 732 at 13 (“CHOP's physician owners ‘stand in the shoes of CHOP, thus creating a direct contractual relationship between CHOP and CHN.... Thus, compensation information regarding CHOP's owners is entirely irrelevant to CHN's alleged Stark Law violations.”).
Moreover, even in the event of a CHN-specific stipulation, Relator would still need to examine the financial relationships between CHN-affiliate defendants and CHOP. No one has suggested that a direct compensation arrangement exists between the CHOP physicians and these other entities.
The Court declines to consider Relator's speculation regarding what CHN knows about CHOP's compensation practices based on Mr. Hutchinson's representation of CHN and CHOP, Mr. Javorka's positions at CHN and CHOP, and/or CHOP physicians’ administrative roles at CHN. (Dkt. 712 at 15-16).
CHOP also notes that the “timing of [Relator's] request is particularly onerous for CHOP because we are finalizing the end of year 2023.” (Dkt. 732-3 at 3). The Court finds this argument unpersuasive. This discovery debate has been brewing for over a year, with the possibility of an amicable resolution growing increasingly unlikely during such time. To the extent CHOP argues that some other part of the fiscal year would be a more opportune time to resolve the present dispute, the Court notes that nothing precluded it from filing a motion to quash before January 23, 2024. And, in any event, it is now over three months since the close of 2023.
That said, the Court strongly encourages Relator and CHOP, as it does all parties, to engage in meaningful discussions concerning the most efficient means of achieving a narrowly tailored production.
The Court does not find it necessary to determine whether the information constitutes a trade secret or merely confidential data. For the purposes of this analysis, the Court will treat it as both.
At the February hearing, counsel was unable to provide a more specific time frame for CHOP's policy of requiring nondisclosure agreements. The Court pauses only to note that this case goes back much farther than several years, regardless of how one defines that term. (See Dkt. 496).
Relator tried to obtain the information from CHN, but was told that CHN “does not have in its possession, custody, and control documents concerning CHOP's payments to individual physicians, Nurse Practitioners and Physician Assistants employed by CHOP.” (Dkt. 712-6 at 4).
CHOP proposes modifying the subpoena to anonymize the production of physician compensation data. (Dkt. 732 at 21). Based on the record before it, however, the Court finds that modifying the subpoena in this manner would preclude Relator from conducting the compensation analysis described above.
CHOP is worried that its information may be introduced and publicized at trial. (Dkt. 732 at 9 n.4). While not dismissing this concern, the Court does not conclude that it necessitates quashing the subpoena.