UNITED STATES of America, Plaintiff, and
James M. Swoben, Qui Tam Relator, Plaintiff-Appellant,
v.
UNITED HEALTHCARE INSURANCE COMPANY, a Connecticut corporation; United Healthcare Services, Inc., Minnesota corporation; UHIC; UnitedHealth Group; UnitedHealthCare; UnitedHealth; PacifiCare Health Plan Administrators, Inc.; UHC of California, FKA PacifiCare of California; PacifiCare Life & Health Insurance Co.; PacifiCare Health Systems; Health Net; WellPoint; Aetna; HealthCare Partners, LLLC; HealthCare Partners Medical Group, Inc.; HealthCare Partners Independent Physician Association, Defendants-Appellees.
United States Court of Appeals, Ninth Circuit.https://leagle.com/images/logo.png
Argued and Submitted December 9, 2015 Pasadena, California.
Filed August 10, 2016.
Attorney(s) appearing for the Case
William K. Hanagami (argued), The Hanagami Law Firm, A.P.C., Woodland Hills, California; Abram J. Zinberg , The Zinberg Law Firm, A.P.C., Huntington Beach, California; for Plaintiff-Appellant James M. Swoben.
David J. Schindler (argued), Latham & Watkins LLP, Los Angeles, California; Roger S. Goldman , Daniel Meron , Jonathan Y. Ellis , and Matthew J. Glover , Latham & Watkins LLP, Washington, D.C.; for Defendants-Appellees UnitedHealthcare Insurance Company, UnitedHealthCare Services Inc., UHIC, UnitedHealth Group, UnitedHealthCare, UnitedHealth, PacifiCare Health Plan Administrators, UHC of California (FKA PacifiCare of California), PacifiCare Life and Health Insurance Company, PacifiCare Health Systems, and Health Net.
David W. Skaar , Hogan Lovells US LLP, Los Angeles, California; Michael C. Theis , Hogan Lovells US LLP, Denver, Colorado; for Defendants-Appellees HealthCare Partners LLC, HealthCare Partners Medical Group, Inc. and HealthCare Partners Independent Physician Association.
David Deaton , O'Melveny & Myers LLP, Newport Beach, California; David J. Leviss , O'Melveny & Myers LLP, Washington, D.C.; Stephen Sullivan , O'Melveny & Myers LLP, Los Angeles, California; for Appellee WellPoint, Inc.
Before: Stephen Reinhardt, Raymond C. Fisher and Jacqueline H. Nguyen, Circuit Judges.
OPINION
Fisher, Circuit Judge:
The Centers for Medicare & Medicaid Services (CMS), administrator of the federal Medicare program, pays Medicare Advantage organizations fixed monthly amounts for each enrollee. CMS calculates the payment for each enrollee based on various "risk adjustment data," such as an enrollee's demographic profile...
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