Full opinion text
RULING ON DEFENDANT YALE-NEW HAVEN HOSPITAL’S MOTION TO DISMISS DORSEY, District Judge. Pursuant to Rules 9(b), 12(b)(1), 12(b)(6) and 12(h)(3) of the Federal Rules of Civil Procedure, Defendant Yale-New Haven Hospital, Inc. (“YNHH”) moves to dismiss the Second Amended Complaint. For the reasons stated below, Defendant’s Motion [Doc. No. 169] is granted. 1. BACKGROUND This lawsuit arises from Plaintiff-Relator’s (“Relator”) employment with Yale University (“Yale”) and YNHH. Relator alleges that Defendant YNHH violated the federal False Claims Act, 31 U.S.C. § 3729, et seq., as amended (“FCA”), by falsely billing and retaining payments from the Medicare and Medicaid Programs for certain radiological services (Count One). Relator also alleges that YNHH and Yale unlawfully retaliated against Relator in violation of the FCA, 31 U.S.C. § 3730(h) (Count Two) and brings a defamation claim against YNHH and Yale (Count Three). Relator Robert C. Smith is a medical doctor licensed to practice medicine in Connecticut and New York and is a resident of the State of New York. Relator was employed by Yale beginning in July 1, 1990 until he was allegedly “forced out” on June 30, 1999. He began as an Instructor at the Yale School of Medicine, was promoted to Assistant Professor in July 1991 and became an Associate Professor in July 1996. Moreover, Relator has served as Associate Professor, Department of Diagnostic Imaging; Chief, Section of MRI, Department of Diagnostic Imaging at Yale’s School of Medicine; Director, Magnetic Resonance Imaging Center; and attending staff physician at YNHH. Most recently, Relator served as a Professor of Radiology and Associate Chair of Information Technology and Systems Administration, Department of Radiology, Cornell University Joan and Sanford I. Weill Medical College, New York Presbyterian Hospital from 1999 until the summer of 2003. Defendant YNHH is reimbursed by Medicare for providing services to eligible patients. According to Relator, YNHH operates a graduate medical education (“GME”) Residency Program paid for, at least in part, by the Medicare Program and under which members of Yale’s School of Medicine faculty and attending physicians at YNHH train Residents and Fellows. The Department of Health and Human Services, acting pursuant to the Medicare statute, has promulgated regulations governing reimbursement for medical services provided to Medicare beneficiaries, including radiological tests and studies. In order to be reimbursed by Medicare for services provided to its beneficiaries, medical service providers must certify that they have complied with applicable requirements in the regulations. Pertinent to this action, Medicare and Medicaid pay only for services that are reasonable, medically necessary and utilized for diagnostic and therapeutic purposes in connection with health care services provided to Medicare and Medicaid beneficiaries. 42 U.S.C. § 1395y(a)(l). If a radiological test is performed by a Resident or Fellow participating in the GME Residency Program at a Teaching Hospital, Medicare and Medicaid will only pay for the Professional Component of diagnostic Radiology Services interpretations that are performed by, reviewed by or interpreted under the supervision of a Teaching Physician. 42 C.F.R. 415.172. Accordingly, the form that physicians must submit to Medicare and Medicaid in order to be entitled to reimbursement includes the following certification: “Signature of Physician or Supplier: I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished incident to my professional service by my employee under my immediate personal supervision.” CMS Form 1500 (the Medicaid certification is identical except that it does not include the word “immediate”). Relator alleges that during his employment, YNHH and Yale violated the FCA by improperly billing and retaining payments from the Medicare and Medicaid Programs for (1) radiological studies for which the signing radiologist did not review the associated image and/or the preliminary report, including alleged billing for: (a) the “clean up project,” (b) the use of the “Autosign” function on the hospital computer system and (c) the review of reports of neuroradiology fellows; (2) studies by radiologists who were not qualified teaching physicians; and (3) medically unnecessary studies, including alleged billing for old studies and unnecessary panels of studies in the emergency room. In an effort to bill for these radiological studies, Relator alleges that YNHH and Yale knowingly engaged in improper billing schemes by falsifying and altering patient records, submitting bills which they knew were in violation of Medicare and Medicaid billing requirements and falsely certifying that they were in conformity with applicable regulations and minimum standards of patient care. A. Relator alleges that YNHH and, Yale billed for radiological studies for which the signing radiologist did not review the associated image and/or the preliminary report Relator alleges that from July 1997 to July 1998, one or more Teaching Physicians finalized Radiology Reports for billing purposes without having ever reviewed the Radiology Study and without having dictated, edited or reviewed the final report. According to Relator’s allegations, the Teaching Physicians’ practice of finalizing the reports in this way “contributed nothing to the diagnosis and/or care of the patient” and therefore “both the Technical Component and the Professional Component were improperly billed to the United States government.” 2d Am. Compl. ¶ 84. Relator also alleges that a “clean up project,” involving the finalization of reports by Yale faculty members after the films had been reviewed by volunteer faculty members, took place between March and May 1998. Relator alleges that Yale fraudulently billed for the Professional Component for interpretations of old radiological studies that were neither performed under the supervision of the attending physicians nor independently reviewed by the attending physician and which had no therapeutic or diagnostic value at the time they were finalized. Relator’s allegations concerning the clean up project principally involve a complaint by one of his colleagues, Dr. Burrell, alleging that he was coerced to sign off on or finalize reports of Radiology Studies for patients seen two years prior with whom Dr. Burrell had never been involved. Dr. Burrell claims that the cases appeared on his sign out queue with his name listed as the attending physician of record. After he refused to sign off the reports, his name was removed and Dean Glickman’s, who allegedly promptly signed off on the reports, was substituted. Id. ¶¶ 58-65, 80-82. Relator alleges that YNHH used the “Autosign” function on the hospital computer system to reflect a fictitious qualified “Responsible Radiologist” of record for the purpose of finalizing radiology reports which were dictated by YNHH’s radiology Residents and Fellows but were never reviewed, approved, edited or certified by the Residents’ or Fellows’ Teaching Physician as required pursuant to the Medicare laws. According to Relator, Autosign was also created for the purpose of finalizing prehminary reports which were dictated by Qualified Radiologists but never reviewed, edited, approved or certified by them prior to finalization. Id. ¶¶ 20, 58-72, 76-78. Relator further alleges that Autosign has additionally been used to move Radiology Studies from “C” status, indicating that a study has never been interpreted, to “F” status, indicating that a study has been interpreted and certified. Id. ¶ 20. Relator alleges that since January 1,1998, at least 1,594 reports of Radiological Studies have been finalized using the Autosign process. Defendant claims that in the email from Felicia Tencza, Yale’s Associate Business manager for the Radiology Department, quoted by Relator in paragraph 58 of the Second Amended Complaint, she made clear that Autosign was created “for the express purpose of flagging preliminary reports for which the slides had been lost before the attending could review them so that Medicare would not be billed.” Mem. Supp. at 3. Relator alleges that a number of faculty members, including himself, repeatedly complained to YNHH Administrators, on both ethical and legal grounds, about the use of Autosign, 2d Am. Compl. ¶ 58-62, and that as a result of his frustration with the University and Hospital’s apathy towards his concerns, he undertook a “comprehensive review” of radiological records dating back to 1998. Upon review, Relator claims that he discovered that “thousands” of reports of Radiology Studies reflecting the initial interpretations of Residents and Fellows had been finalized by Autosign or by physicians who had never reviewed the films and who had not supervised the Resident or Fellow when the Studies were interpreted. Moreover, Relator alleges that “upon information and belief,” the films and/or images associated with the Autosign studies were lost and were never repeated, retrieved or found. Id. ¶ 69. B. Relator alleges that YNHH and Yale billed for studies by radiologists who ivere not qualified teaching physicians Relator further claims that since July 22, 1998, outside clinical attending physicians not authorized to bill Medicare as Teaching Physicians finalized reports by Residents and Fellows. Specifically, he names Bruce Simmons, M.D., who allegedly finalized, 34 such reports, and Andy Haims, M.D., who allegedly finalized 1,024 such reports. Id. ¶ 75. Relator claims that “upon information and belief,” Defendant YNHH billed Medicare and Medicaid for the Professional Component of Radiology Studies that were never reviewed by a Qualified Radiologist. Id. ¶ 76. C. Relator alleges that YNHH and Yale billed for medically unnecessary studies, including alleged billing for old studies and unnecessary panels of studies in the emergency room Relator alleges that since 1995, YNHH Radiology Department faculty has interpreted and issued final reports on “old” studies “long after the point in time when they can be considered medically necessary.” Id. ¶ 55. Relator claims that various Department Heads and Managers have “directed and made numerous attempts to intimidate Yale’s Radiology Department faculty members to review and interpret these old Radiology Studies and furnish finalized reports for which Yale could and would bill the Professional Component, even though the delayed interpretations had no therapeutic or diagnostic value ...” Id. ¶ 56. Relator further alleges that pursuant to “long-standing practice” and as part of departmental policy at YNHH, certain panels of diagnostic tests are routinely ordered, regardless of whether they are medically indicated, prior to patients being examined or evaluated by “appropriate medical providers.” Relator claims that this practice violates Medicare and Medicaid billing requirements. Id. ¶ 89. After the Original Complaint was filed in this action, Relator deleted the “completed but not read” allegations against YNHH from this action and filed them in a subsequent action, discussed below as “Qui Tam Two.” In the Ruling on Relator’s Motion for Reconsideration in the related action, docket number 03:02cvl205, the allegations against YNHH in that action were dismissed, but the two actions were consolidated and Relator has been granted leave to amend the Second Amended Complaint in this action in order to re-incorporate the particulars of the “completed but not read” allegations. In the interests of efficiency, the related allegations against YNHH will be dealt with in conjunction with the similar issues raised by Cornell and New York Presbyterian Hospital in their Motions to Dismiss filed in Qui Tam Two. Relator claims to have met with Representatives from the Department of Justice several times in the fall of 1998 and the fall of 1999, at which times he says that he “outlined Defendant’s practices which resulted in the submission of false claims to Medicare.” Opp’n at 6 (citing Smith Aff., Opp’n Exh. A ¶¶ 12, 17, 19, 22). Further, Relator alleges that he and two colleagues, Dr. Rosenfield and Dr. Burrell, met with Richard Levin, the President of Yale University, to discuss what they perceived to be fraudulent activity.2d Am. Compl. ¶ 80. Following that meeting, Relator claims to have discussed the matter again, along with Drs. Rosenfield and Burrell, with Defendant’s General Counsel. Id. ¶ 81. Relator alleges that after he began investigating and reporting the policies and procedures at issue here, YNHH and Yale, through their officers, agents and employees, harassed and discriminated against him in the terms and conditions of his employment by, inter alia, intimidating him, cutting his salary, stripping him of his administrative positions and titles, forcing him to resign, interfering with his attempts to obtain other employment, forcing him to leave the State of Connecticut and publicly defaming him. Relator alleges that YNHH and Yale similarly retaliated against Dr. Arthur T. Rosenfield and Dr. Morton I. Burrell. Relator asserts that he was discriminated against because of his investigation and reporting of the alleged frauds at issue here, including his reports of the substandard patient care issues, improper billing practices and corporate falsification of documents.2d Am. Compl. ¶¶ 98-103. Finally, Relator alleges that YNHH and Yale publicly defamed him by making statements to third parties which were false, injurious and known to be false at the time they were made and thus were reckless and wanton. Relator claims that these statements caused harm to his reputation and professional image with his colleagues and in the community and caused severe mental and emotional distressed Am. Compl. ¶¶ 104-107. Relator filed the present qui tam action on or about July 19, 2000. He filed a subsequent qui tam action against Yale, YNHH and other defendants not parties to this action on or about July 12, 2002. For the purposes of this Ruling, the later filed action, 3:02cvl205 (PCD), will be referred to as Qui Tam Two and the present action Qui Tam One. Following the filing of this motion, the parties filed a stipulation dismissing defendant Yale University from both Qui Tam One and Qui Tam Two. On January 7, 2002, more than six months prior to filing either Qui Tam One or Qui Tam Two, Relator brought an action in Connecticut state superior court alleging violations of state law concerning his employment with YNHH and Yale. See Burrell v. Yale Univ., 00-cv-0159421-S (Conn.Super. Waterbury Dist.) (the “State Court Action”). The claims asserted in the State Court Action include claims for retaliation under Section 31-51q of the Connecticut General Statutes,, breach of contract and constructive discharge. The details of these other actions will be discussed further, as necessary, below. II. DISCUSSION “The False Claims Act authorizes private citizens to sue on behalf of the United States to recover treble damages from those who knowingly make false claims for money or property upon the Government or who knowingly submit false statements in support of such claims or to avoid the payment of money or property to the Government.” United States ex rel. Lissack v. Sakura Global Capital Mkts., Inc., 377 F.3d 145, 146 (2d Cir.2004) (citing 31 U.S.C. § 3729 et seq.). The FCA imposes liability on any person who: (1) knowingly presents, or causes to be presented, to an officer or employee of the United States Government or a member of the Armed Forces of the United States a false or fraudulent claim for payment or approval; (2) 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; (3) conspires to defraud the Government by getting a' false or fraudulent claim allowed or paid; 31 U.S.C. § 3729(a). The Act also contains a “qui tam provision,” which empowers persons—“relators”—to sue false claimants on behalf of the government. United States ex rel. Drake v. Norden Sys., 375 F.3d 248, 251 (2d Cir.2004); 31 U.S.C. § 3730(b). A relator must bring the action in the name of the- government, serve the complaint on the government, file the complaint under seal and allow the government to intervene. 31 U.S.C. § 3730(b). The government has an initial sixty-day period, extendable “for good cause shown,” to decide whether to intervene. Id. Before expiration of its time limit, the government must intervene and prosecute the case or notify the court that it declines to do so, whereupon the relator has the right to proceed with the action. 31 U.S.C. § 3730(c). In either case, the relator is entitled to a percentage of any award received. 31 U.S.C. § 3730(d). The government has elected not to intervene in the instant action. A. False Claims Act: Section 3729 Claims 1. Subject Matter Jurisdiction under 31 U.S.C. § 3730(e)(W The FCA contains a public disclosure bar that deprives courts of subject matter jurisdiction in cases based on publicly disclosed information unless the person bringing the action is the original source of that information, 31 U.S.C. § 3730(e)(4)(A),, which provides in pertinent part: No court shall have jurisdiction over an action under this section based upon the public disclosure of allegations or transactions in a criminal, civil, or administrative hearing ... unless the action is brought by the Attorney General or the person bringing the action is an original source of the information. As is clear from the language of the statute, the satisfaction of section 3730(e)(4)(A) is an issue of subject matter jurisdiction. United States ex rel. Kreindler & Kreindler v. United Technologies Corp., 985 F.2d 1148, 1157 (2d Cir.1993). This public disclosure bar was added to the FCA in 1986 in an effort to strike a balance between encouraging “those with knowledge of fraud against the government to bring that information to the fore” and “avoiding parasitic actions by opportunists who attempt to capitalize on public information without seriously contributing to the disclosure of the fraud.” United States ex rel. Doe v. John Doe Corp., 960 F.2d 318, 321 (2d Cir.1992). a. Standard of Review Defendant moves to dismiss Relator’s Second Amended Complaint for lack of subject matter jurisdiction pursuant to Rules 12(b)(1) and 12(h)(3) of the Federal Rules of Civil Procedure. The Relator, as the party asserting subject matter jurisdiction, has the burden of establishing that it exists in this case, Malik v. Meissner, 82 F.3d 560, 562 (2d Cir.1996), and the court should not draw argumentative inferences in his favor. Atlantic Mutual Ins. Co. v. Balfour Maclaine Int’l, 968 F.2d 196, 198 (2d Cir.1992). When considering a motion to dismiss, however, the court must accept the facts alleged in the complaint as true. See Jaghory v. New York State Dep’t of Educ., 131 F.3d 326, 329 (2d Cir.1997). A court ruling on a Rule 12(b)(1) motion to dismiss must first determine whether the defendant is bringing a facial or factual challenge to its jurisdiction. See United States ex rel. Cosens v. Yale-New Haven Hosp., 233 F.Supp.2d 319, 320 (D.Conn.2002) (citing Gould Elecs., Inc. v. United States, 220 F.3d 169, 176 (3d Cir.2000); 2 Moore’s Federal Practice § 12.30(4) (2002 3d ed.)). The jurisdictional challenge in this case is factual in nature, since Defendant does not challenge the sufficiency of the pleadings, but argues, on a factual basis, that Relator’s jurisdictional claims fail to comply with the requirements set forth in section 3730(3)(4) of the FCA. Since Defendant’s challenge is a factual one, the Court is not limited to the face of the complaint in considering this motion. See Cosens, 233 F.Supp.2d at 320 (citing Robinson v. Government of Malaysia, 269 F.3d 133, 141 (2d Cir.2001); 2 Moore’s at § 12.30(4)). Rather, the Court is free, and even required, to weigh and consider evidence outside the pleadings to determine whether subject matter jurisdiction exists. See id. (citing Filetech S.A. v. France Telecom S.A., 157 F.3d 922, 932 (2d Cir.1998); Zappia Middle E. Constr. Co. v. Emirate of Abu Dhabi, 215 F.3d 247, 253 (2d Cir.2000) (in resolving a Rule 12(b)(1) motion, district courts may “resolve the disputed jurisdictional fact issues by referring to evidence outside of the pleadings, such as affidavits, and if necessary, hold an evidentiary hearing”)); see also Phoenix Consulting, Inc. v. Republic of Angola, 216 F.3d 36, 40 (D.C.Cir.2000) (“When the defendant has thus challenged the factual basis of the court’s jurisdiction ... the court must go beyond the pleadings and resolve any disputed issues of fact the resolution of which is necessary to a ruling upon the motion to dismiss.”). Therefore, a court must “look to the substance of the allegations to determine jurisdiction.” Cargill Int'l S.A. v. M/T Pavel Dybenko, 991 F.2d 1012, 1019 (2d Cir.1993). As stated previously, Defendant is moving to dismiss Relator’s Second Amended Complaint pursuant to Rules 9(b), 12(b)(1), 12(b)(6) and 12(h)(3) of the Federal Rules of Civil Procedure. When a party moves to dismiss pursuant to Rule 12(b)(1) in addition to other bases, such as Rule 12(b)(6), “the court should consider the Rule (12)(b)(l) challenge first since if it must dismiss the complaint for lack of subject matter jurisdiction, the accompanying defenses and objections become moot and do not need to be determined.” Rhulen Agency, Inc. v. Alabama Ins. Guaranty Ass’n., 896 F.2d 674, 678 (2d Cir.1990). b. Whether Rule 12(b)(1) is the Proper Vehicle for Challenging Subject Matter Jurisdiction under Section 3730(e) (h) Relator challenges the propriety of considering YNHH’s arguments in a Rule 12(b)(1) motion, arguing that the Second Circuit has never “squarely addressed” whether a 12(b)(1) motion is the appropriate vehicle to challenge subject matter jurisdiction. Opp’n at 8-11. As previously decided in this Court’s Ruling on YNHH’s Motion to Dismiss in Qui Tam Two, subject matter jurisdiction under § '3730(e)(4) may be resolved in a 12(b)(1) motion to dismiss. Therefore, the Court will consider the merits of YNHH’s motion regarding jurisdiction as it did in the prior Ruling. See United States ex rel. Smith v. Yale-New Haven Hosp. Inc., 411 F.Supp.2d 64, 68-70, 2005 WL 2072514, at *4-6, 3:02cv1205 (PCD), 2005 U.S. Dist. LEXIS 19298, at *14-19 (D.Conn.2005). c. Whether there was a Public Disclosure Prior to the Filing of the Original Complaint The first question in the public disclosure bar analysis is whether there has been a public disclosure. Defendant argues that the public disclosure in this case took place on or about January 7, 2000, the date on which the State Court Action was filed. Mem. Supp. at 7. Section 3730(e)(4)(A) provides an exclusive list of the situations in which the public disclosure jurisdictional bar applies, such that if the public disclosure does not occur in “a criminal, civil, or administrative hearing, in a congressional, administrative, or Government Accounting Office report, hearing, audit, or investigation, or from the news media,” the qui tam action is not barred. See Doe, 960 F.2d at 323. The phrase “in the course of a civil, criminal, or administrative hearing” should be interpreted broadly, so as to include “allegations and information disclosed in connection with civil, criminal, or administrative litigation,” including information disclosed during discovery. United States ex rel. Stinson, Lyons, Gerlin & Bustamante, P.A. v. Prud. Ins. Co., 944 F.2d 1149, 1156 (3d Cir.1991); United States ex rel. Siller v. Becton Dickinson & Co., 21 F.3d 1339, 1350 (4th Cir.1994) (“Given the fluidity in the meaning of the term ‘hearing,’ and the fact that we can discern no reason why Congress might have intended otherwise, we agree with our sister Circuits ... that an entire civil proceeding can constitute a ‘hearing’ for purposes of section 3730(e)(4)(A).”). Under this approach, the “disclosure of discovery material to a party who is not under any court imposed limitation as to its use is a public disclosure under the FCA” regardless of whether such discovery has been filed with the court. Stinson, 944 F.2d at 1158; Kreindler, 985 F.2d at 1157 (adopting, without explanation, the approach set out in Stinson ). As the public disclosure jurisdictional bar applies only when a complaint is “based upon” publicly disclosed information, 31 U.S.C. § 3730(e)(4)(A), Defendant also argues that the allegations disclosed in the State Court Action are “substantially similar” to the allegations in the instant action. Id. at 8-9. The Second Circuit, as well as a majority of other circuits, have held that a qui tam action is “based upon” a public disclosure when the allegations of fraud or the critical elements of the fraudulent transaction are “the same as those that have been publicly disclosed----regardless of where the relator obtained his information.” Doe, 960 F.2d at 324; accord Kreindler, 985 F.2d at 1158; United States ex rel. Dick v. Long Island Lighting Co., 912 F.2d 13, 17 (2d Cir.1990); United States ex rel. Springfield Terminal Ry. Co. v. Quinn, 14 F.3d 645, 654 (D.C.Cir.1994); United States ex rel. Mistick PBT v. Hous. Auth., 186 F.3d 376, 388 (3d Cir.1999) (holding that “a qui tam action is ‘based upon’ a qualifying disclosure if the disclosure sets out either the allegations advanced in the qui tam action or all of the essential elements of the qui tam action’s claims”). Relator does not dispute that the State Court Action constituted a disclosure or that the qui tam action was based on the disclosure, but simply argues that Relator qualified as an original source prior to the disclosure. Opp’n at 11. d. Whether Relator Qualifies as an “Original Source” As there is no dispute in this case over whether there was a public disclosure of the allegations prior to filing the original complaint, the dispositive question here is whether Relator qualifies as an original source despite the public disclosure. See 31 U.S.C. § 3730(e)(4)(A); Koch, 971 F.2d at 553 (“[A] plaintiff whose qui tam action is based in any part upon publicly disclosed allegations or transactions is subject to the ‘original source’ jurisdictional requirement.”); see also Wang ex rel. United States v. FMC Corp., 975 F.2d 1412, 1417 (9th Cir.1992) (holding that the fact of a subsequent public disclosure “does not rob [the relator] of what he saw with his own eyes”). An “original source” under the FCA is one who (1) “has direct and independent knowledge of the information on which the allegations are based,” (2) “has voluntarily provided the information to the Government before filing an action under this section” and (3) has “directly or indirectly been a source to the entity that publicly disclosed the allegations on which the suit is based.” 31 U.S.C. § 3730(e)(4)(B); United States v. New York Med. Coll., 252 F.3d 118, 120 (2d Cir.2001) (citations omitted); see also Kreindler, 985 F.2d at 1159 (discussing the Second Circuit’s decision to include the third requirement). i. Whether Relator has “Direct and Independent” Knowledge Importantly, the statute requires the relator to have direct and independent knowledge. “Independent knowledge” is that which is not dependent on public disclosures. See Stinson, 944 F.2d at 1160; Kreindler, 985 F.2d at 1158. Although a relator need not possess all relevant information in order to have “independent” knowledge, he or she must possess “substantive information about the particular fraud, rather than merely background information which enables a putative relator to understand the significance of a publicly disclosed transaction or allegation.” Stinson, 944 F.2d at 1160. “Direct” knowledge is that which is “marked by [the] absence of an intervening agency, instrumentality, or influence: immediate.” Id. (quoting Webster’s Third New International Dictionary 640 (1976)). Clearly, “[a] relator has direct knowledge when he sees [the fraud] with his own eyes,” and thus, the “paradigmatic ‘original source’ is a whistleblowing insider.” United States ex rel. Kinney v. Stoltz, 327 F.3d 671, 674 (8th Cir.2003) (noting that the FCA “is intended to encourage individuals who are either close observers or involved in the fraudulent activity to come forward, and is not intended to create windfalls for people with secondhand knowledge of the wrongdoing”); Stinson, 944 F.2d at 1161 (referring to the Senate Report’s statement that “individuals who are close observers or otherwise involved in fraudulent activity” are possible relators) (quoting S. REP. NO. 345, at 4, as reprinted in 1986 U.S.C.C.A.N. pp. 5266, 5269). Direct knowledge is that which comes from the relator himself and thus one cannot qualify as an “original source” if “a third party is the source of the core information upon which a qui tarn complaint is based.” New York Med. Coll., 252 F.3d at 121 (emphasis added); Kreindler, 985 F.2d at 1159. It is therefore not necessary for a relator to have all the relevant information in order to qualify as independent so long as the relator possesses substantive, or core, information about the particular fraud. See New York Med. Coll., 252 F.3d at 121; Kreindler, 985 F.2d at 1159. Merely possessing background information which enables the relator to understand the significance of a publicly disclosed transaction or allegation, however, is insufficient. See Stinson, 944 F.2d at 1160, cited by Kreindler, 985 F.2d at 1159 (“[The qui tarn plaintiff] had no significant direct knowledge ... and certainly was not a source of that information ... The fact that [the qui tarn plaintiff] conducted some collateral research and investigations ... does not establish ‘direct and independent knowledge of the information on which the allegations are based’ within the meaning of § 3730(e)(4)(B).”). Relator cites Quinn, 14 F.3d at 657, for the proposition that a relator need only have direct and independent knowledge of any essential element of the underlying fraud transaction in order to qualify as an original source. Opp’n at 17. Relator cites no case from this Circuit in support of that proposition. Moreover, as noted above, the Second Circuit has made clear that a relator must possess, at the very least, substantive, or core, information about the particular fraud in order to qualify as an original source. See New York Med. Coll., 252 F.3d at 121; see also Kreindler, 985 F.2d at 1159. Moreover, the Quinn approach advocated by Relator has been criticized for its deviation from the standard set forth in the FCA: The lQuinn~\ approach is inconsistent with the plain language of the FCA, which should govern the court’s interpretation. As noted earlier, the statute provides that an original source is someone who has “direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the Government before filing an action under this section which is based on the information.” 31 U.S.C. § 3730(e)(4)(B). The statute does not provide that all that is necessary is that the relator have “direct and independent knowledge of some of the information on which the allegations are based.” Even with the understanding that “based” should be construed to be “supporting,” there is no indication in the language of the statute that the supporting information need only provide a fraction of the necessary elements of the allegation. United States ex rel. Hafter v. Spectrum Emergency Care, Inc., 9 F.Supp.2d 1273, 1277 (D.Kan.1998) (citations omitted) (emphasis added); see also United States ex rel. Stone v. Rockwell Int’l Corp., 282 F.3d 787, 802 (10th Cir.2002) (explaining the Hafter holding and adding that “[t]he relator need not ... have in his possession knowledge of the actual fraudulent conduct itself; knowledge ‘underlying or supporting’ the fraud allegation is sufficient”). Therefore, although Relator need not prove that he had direct and independent knowledge of all of the information on which the allegations are based, he must show that he had direct and independent knowledge of the core information upon which his allegations of fraud are based. A. Conduct Allegedly Occurring After Relator Left Yale Defendant argues that as many of the allegations in the Complaint took place at Yale after June 30, 1999, the date on which Relator left Yale, Relator cannot have “direct and independent knowledge” of any of the post-June 1999 allegations. Mem. Supp. at 12 (citing Compl. ¶¶ 7, 83-91; 2d Am. Compl. ¶¶ 7, 68-76, 79-81). In a similar context, Stone held that the defendant’s argument that the relator could not be an “original source” because he no longer worked for the defendant corporation when the allegedly fraudulent activity commenced was “immaterial to the relevant question, which is whether [the relator] had direct and independent knowledge of the information underlying the claim,” which, in that case, was defendant’s awareness that it would be engaging in fraudulent activities. Stone, 282 F.3d at 802-803. To the extent that Relator is seeking to establish direct and independent knowledge of conduct that occurred after his departure from YNHH, he is permitted so long as the allegations flow from matters over which he had direct knowledge while employed. See Stinson, 944 F.2d at 1160 (holding that a relator need not have direct knowledge of every fact alleged). Assuming that conduct substantially similar to that of which Relator has direct knowledge continued after his departure, it would not be in the ultimate interest of Government recovery to limit an action solely to conduct that occurred during his employment. A review of the Second Amended Complaint reveals only a small number of allegations involving conduct taking place after June 30,1999: 68. [Relator Smith’s] review encompassed those reports ... finalized by “Autosign” from the period from Janu ary 1, 1998 to May 2000, and other reports finalized “after-the-fact” which had never been interpreted or finalized 88. Upon information and belief, tens of thousands of additional instances of fraud in the signing of reports has occurred since July 1998 and continues to the present time. 89. It is a long-standing practice ... that certain panels of diagnostic tests, including Radiology Studies, are routinely ordered as a matter of practice .... 2d Am. Compl. ¶¶ 68, 88, 89 (emphasis added). All of these instances of alleged conduct occurring after Relator’s departure involve conduct that began during his employment and continued after his departure. Therefore, as the “information underlying the claim” commenced during Relator’s employment, he is not prevented from establishing “direct and independent knowledge” solely because the conduct continued after his departure. Defendant also points to Relator’s claim that he “reviewed a serious of radiology reports in the DecRad System [which had been] finalized for the period from January 1, 1998 to May 2000” and to Relator’s following discussion of his investigation. Mem. Supp. at 13 (citing Compl. ¶¶ 83-91; 2d Am. Compl. ¶¶ 68-76). Defendant notes that Relator has not explained how, almost a year after leaving Yale to work at Cornell, he obtained access to YNHH’s computer system in order to conduct his review. See id. Although the key question is whether Relator has direct and independent knowledge of the information and not how he obtained it, Defendant does call the credibility of Relator’s assertion into question. See Stone, 282 F.3d at 802-03 (holding that the fact that the relator was no longer employed by and not “physically present” at the defendant company when the illegal activity began was irrelevant; the relevant question was whether he had “direct and independent knowledge of the information underlying his claim”). Relator’s presence at YNHH when the activity occurred would be relevant as bearing on the question of Relator’s ability to prove that he had “direct and independent knowledge” of the information in question. The issue of how he obtained the knowledge is essential to his being an original as opposed to a secondary source. This Court finds, on the present record, that Relator has not proved that he was an original source as to the information presented in paragraphs 68-76 of the Second Amended Complaint on the present record. Relator also claims that he possesses firsthand, direct knowledge of ‘Yale’s long standing practice of automatically submitting claims for reimbursement for the Professional Component of all radiology tests and procedures once they are in ‘F’ status in the DecRad system,” Exh. A ¶¶ 9-11, 16, 18, and ‘YNHH’s long standing practice of automatically submitting claims for the Technical Component of radiology tests and procedures once the exam is placed in ‘C’ status in the DecRad system.” Exh. A ¶¶ 7, 12, 21. Defendant maintains that these claims are “simply wrong,” arguing that Relator cannot possess “direct and independent” knowledge sufficient to establish jurisdiction when such knowledge is “demonstrably false.” Def.’s Reply at 7. As the Tenth Circuit Court of Appeals held in Stone, however: For a relator to be properly qualified as an original source, he must have had direct and independent knowledge of the information on which his claim is based. But whether that claim is ultimately flawed on the merits is an analytically distinct question from the one mandated by the FCA for establishing jurisdiction. It is for the finder of fact to determine whether the plaintiffs theory has merit; to satisfy the direct and independent prong of the original source test, the relator need only show that he possessed direct and independent knowledge of the information upon which his claim is based, not that his claim is factually correct. 282 F.3d at 803. Similarly, Defendant’s objection to Relator’s knowledge here also does not have merit; whether Relator’s allegations are true is immaterial to the present inquiry. B. Facts Obtained via Discovery in State Court Action Defendant argues that the jurisdictional bar applies because a large part of the newly pled allegations in the Second Amended Complaint come from information disclosed during the discovery process in the State Court Action. Mem. Supp. at 15-16 (citing 2d Am. Comp. ¶ 85, which states that “[a] review of Defendants’ records provided thus far has revealed ...” and ¶ 88, which cites a “recent admission of Dr. Gordon Sze”). Although disclosure by itself is not sufficient to defeat jurisdiction if the relator is the source of the information disclosed, Defendant correctly asserts that if Relator had obtained information regarding post-June 1999 transactions through discovery in the State Court Action, he would not, as a matter of law, have “independent” knowledge of that information. See Kreindler, 985 F.2d at 1158 (holding that relator is not an original source as to information produced during discovery); Dick, 912 F.2d at 18 (“[I]f the information on which a qui tarn suit is based is in the public domain, and the qui tam plaintiff was not a source of that information, then the suit is barred.”); Stinson, 944 F.2d at 1158 (holding that discovery exchanged between private parties but not filed with the court is “publicly disclosed” because it is potentially accessible to the public); United States ex rel. Pentagen Techs. Int’l Ltd. v. CACI Int’l, Inc., 94-cv-2925 (RLC), 1996 WL 11299, at *8 (S.D.N.Y. Jan. 4, 1996) (“[T]he Second Circuit holds that the party divulging the information deemed publicly disclosed by litigation papers, such as depositions, is the original source of that information despite the fact that another party initiated the court proceeding as part of its discovery investigation.”). Defendant argues that certain allegations in the Second Amended Complaint— specifically, those in paragraphs 85 and 88 — were obtained by way of discovery in the State Court Action and should be dismissed. Mem. Supp. at 15-16. As the Section containing these allegations appears in the Second Amended Complaint but not in the Original Complaint, which was filed six months earlier, Defendant’s argument appears to carry some weight. The statement that “[a] review of the Defendants’ records provided thus far has revealed evidence of the alleged Neuroradiology Fellow and Resident Billing fraud,” appears to indicate that the records were produced and the relevant evidence gathered during discovery. 2d Am. Compl. ¶ 85. Thus, as to the evidence mentioned in paragraph 85, it appears that YNHH and/or Yale — and not Relator— were the “original sources.” See Kreindler, 985 F.2d at 1159 (holding, where the defendant produced documents and information during discovery, that the defendant “was clearly the source of the core information”). Similarly, Relator’s citation in paragraph 88 of a “recent admission of Dr. Gordon Sze” in support of his assertion that “[u]pon information and belief, tens of thousands of additional instances of fraud in the signing of Reports has occurred since July 1998 and continues to the present time,” bolsters the conclusion that these allegations are based on information produced during discovery and not on Relator’s own direct and independent knowledge. Accordingly, the only question here is whether the information produced on which Relator relies is “core” information or whether it is merely additional evidence supporting Relator’s allegations. It seems, with regard to Relator’s allegation that Residents and Neuroradiology Fellows were used to facilitate fraudulent billing practices in paragraphs 83-88 of the Second Amended Complaint, that Relator does not have direct knowledge of the information forming the “core” of the allegation. Although it is not clear from the face of the Complaint, Relator appears to not have direct knowledge of the allegation in paragraph 84, which says that “the essence of the claim” was “first raised by Resident Physicians.” 2d Am. Compl. ¶ 84. Moreover, the evidence that Relator provides appears to have been obtained through discovery in the State Court Action. For example, Relator says that certain evidence was revealed by “[a] review of Defendants’ records provided thus far,” and discusses information “contained in a Hogan & Hartson investigative report.” Id. ¶ 85. Similarly, Relator discusses other knowledge apparently “based on the handwritten notes taken by President Levin.” Relator does not explicitly state where he obtained the information, but the statements in the complaint and the fact that the allegations were not present in the Original Complaint lead to the conclusion that these facts were discovered after the filing of the Original Complaint, most likely by virtue of discovery in the State Court Action. Based on his review of the aforementioned documents, Relator makes his own “unavoidable inferences” and conclusions, but the basis of these allegations comes from information provided by other sources. As a matter of law, Relator cannot claim to be the original source of information disclosed during discovery in the State Court Action. Accordingly, the Court finds that it does not have subject matter jurisdiction over the allegations found in paragraphs 83-88 of the Second Amended Complaint. C. Information Obtained from Third Parties With respect to Relator’s claims regarding the “clean up project,” Defendant argues that “it is clear from the face of the Complaint that the allegations are based on secondhand information from Dr. Burrell.” Mem. Supp. at 15 (citing Compl. ¶¶ 77-80; 2d Am. Compl. ¶¶ 62-65). As Defendant alleges, Relator’s allegations in paragraphs 62-65 of the Second Amended Complaint are clearly based on information provided to him by Dr. Burrell, however, that fact will not defeat jurisdiction if, as discussed earlier, the information forming the basis of the complaint is within Relator’s “direct and independent” knowledge. See Stone, 282 F.3d at 802-03 (“The relator need not ... have in his possession knowledge of the actual fraudulent conduct itself; knowledge ‘underlying or supporting’ the fraud allegation is sufficient.”). This is not the case here, however, where it is evident that the core information about the clean up project came from Dr. Burrell. For Relator’s knowledge to be “independent,” it “must not be derivative of the information of others, even if those others may qualify as original sources.” See United States ex rel. Fine v. Advanced Sciences, Inc., 99 F.3d 1000, 1007 (10th Cir.1996) (holding that the relator “did not qualify as an original source because his knowledge was secondhand and derivative of the information generated by [others] who actually ... uncovered the facts”); Hays v. Hoffman, 325 F.3d 982, 991 (8th Cir.2003) (holding that the relator was not an original source as to information obtained from a co-worker; such information “is neither direct nor independent”). Although Dr. Burrell may be an original source of the information— which is not clear on the present record— Relator unquestionably obtained the information from him and therefore does not have direct and independent knowledge of it. As a matter of law, Relator cannot claim to be an original source of information derived from third parties. See Doe, 960 F.2d at 321 (discussing the purpose of the 1986 amendments to the FCA as “striking] a balance between encouraging private citizens to expose fraud and avoiding parasitic actions by opportunists who attempt to capitalize on public information without seriously contributing to the disclosure of the fraud”); Kinney, 327 F.3d at 674 (“The [FCA] ... is not intended to create windfalls for people with secondhand knowledge of the wrongdoing.”). Therefore, this Court finds that it does not have subject matter jurisdiction over the allegations in paragraphs 62-65 of the Second Amended Complaint. Defendant cites further examples of Relator conceding that he does not have “direct or independent” knowledge of various allegations, including Relator’s testimony in the State Court Action that he has “no idea” and is “not claiming one way or the other” whether YNHH was billing for Autosign. Doyle Deck Exh. J at 521:4-13; see also Compl. ¶¶ 20, 72-76, 81-89, 91-93; 2d Am. Compl. ¶¶20, 57-61, 66-74, 76-78 (“Autosign” claims). Defendant also points to Relator’s admission with respect to his claims that YNHH billed for medically unnecessary panels of tests, Compl. ¶¶ 96-99; 2d Am. Compl. ¶¶ 89-92, that he has “no way of knowing” whether the memo in question either ordered fraudulent billing or was even put into effect. Doyle Deck Exh. K at 604:5-11, 607:10-14. Relator’s admissions that he does not know whether fraudulent billing occurred are troublesome. It is clear that Relator must establish “direct and independent” knowledge of an actual FCA violation— which includes the actual submission of false claims. See United States ex rel. Karvelas v. Melrose-Wakefield Hosp., 360 F.3d 220, 225 (1st Cir.2004) (noting that evidence of an actual false claim is “the sine qua non of a False Claims Act violation”). Relator, however, maintains that he does have direct and independent knowledge of the information underlying the allegations of fraud, having obtained such information firsthand during his tenure as a Teaching Physician in Defendant’s employ. Opp’n at 13 (citing Exh. A ¶¶ 13-22). Specifically, Relator argues that he possesses firsthand, direct knowledge “of Yale’s long standing practice of automatically submitting claims for reimbursement for the Professional Component of all radiology tests and procedures once they are in “F” status in the DecRad system,” Exh. A ¶¶ 9-11, 16, 18, “of YNHH’s long standing practice of automatically submitting claims for the Technical Component of radiology tests and procedures once the exam is placed in “C” status in the DecRad system,” Exh. A ¶¶ 7, 12, 21, as to how Autosign was going to be used, Exh. C, “of the fraudulent finalization of preliminary reports written by Residents and Fellows ... because he discussed with actual Residents the fact that the respective faculty members were routinely signing off on the reports without reviewing the associated images or the reports,” Exh. A ¶ 15, and “of the Clean up project because he discussed with actual faculty who were coerced into participating in the fraud and because Plaintiff independently investigated and reviewed the computer records of specific cases that were part of the fraud,” Exh. A ¶¶ 18-19. Relator argues that this direct knowledge is “clearly evident” in the independent review he performed of fraudulently finalized reports, his complaints to Felicia Tencza, and his meetings with Yale President Levin and Yale’s General Counsel on the matter. Opp’n at 14 (citing 2d Am. Compl. ¶¶ 58-61, 66-76, 80-82, 84, 89, 90, 98, 101; Exh. A ¶¶ 13-22). Although Relator’s investigation/review could lead to information which he would have direct and independent knowledge of, if his admissions are to the contrary, then they would control over the allegations in his complaint. As discussed above, Defendant cited several examples of Relator conceding that he does not have knowledge of the information forming the basis of the complaint, that is, that fraudulent billing occurred. Since Relator presents no evidence that he had direct and independent knowledge of fraudulent billing and since his admissions suggest none, there is insufficient evidence for this Court to find that Relator is an original source as to the allegations in paragraphs 20, 57-61, 66-74, 76-78 and 89-92 of the Second Amended Complaint. Similarly, Defendant argues that Relator has demonstrated that his claim about billing for reports prepared by Neuroradiology Fellows in paragraphs 83-88 of the Second Amended Complaint is based on information obtained from third parties and therefore is “derivative of the information of others” and not “independent.” Def.’s Reply at 9; see also Mem. Supp. at 13-15. Defendant alleges that Relator has admitted to not having direct and independent knowledge of these alleged fraudulent activities, citing a filing in the State Court action in which Relator conceded, along with the other plaintiffs in that action, that he “did not directly observe or participate” in those activities. Doyle Decl. Exh. G at 2. In that filing, the State Court plaintiffs stated that “the source of these allegations [of alleged fraudulent activities relating to the overreading of the neuroradiology fellows] are numerous current and former radiology residents who directly and reluctantly participated in these activities.” Id. Similarly, in information produced during discovery in the State Court Action, Relator concedes that the plaintiffs in that action “did not claim that Yale had billed for these studies; it was enough of a violation of law and medical ethics for a physician to place his name on a report certifying he had reviewed the film when he had not.” Id. Exh. I at 5. For purposes of this action, however, the question of whether these practices violated law and medical ethics is irrelevant — it is false or fraudulent billing which is the sine qua non of an FCA violation. Since there is no violation without false or fraudulent billing, Relator’s statement casts considerable doubt on the viability of these claims. His silence on the subject suggests that he possessed no knowledge of any fraudulent billing, for if he did, presumably, he would have made that fact clear. Therefore, the evidence on the record at this point suggests that all that Relator was told and all that he knew was that the reports were signed. In the Reply, Defendant also claims that Relator admits in this action that he obtained the information secondhand, citing Relator’s argument that he “has direct knowledge of the fraud[ ] ... because he discussed [it] with actual Residents.” Def.’s Reply at 8 (citing Opp’n at '14). Moreover, Defendant points to Relator’s statement that he has “direct knowledge of the Clean up project because he discussed with actual faculty who were coerced into participating in the fraud and because Plaintiff independently investigated and reviewed the computer records specific cases that were part of the fraud,” Exh. A ¶¶ 18-19, and argues that these statements “turn the meaning of ‘direct’ on its head,” as Relator “concedes that his information ... was obtained secondhand rather than by personal observation.” Relator, on the other hand, claims that he followed the information up with his own independent investigation. Opp’n at 14. Numerous courts have held that knowledge that is “unmediated by anything by [relator’s] own labor” or derived from information obtained firsthand through relator’s own labor is “direct.” See, e.g., Wang, 975 F.2d 1412 (9th Cir.); Cooper, 19 F.3d at 568 (11th Cir.); Houck, 881 F.2d at 505 (7th Cir.); Quinn, 14 F.3d at 656 (D.C.Cir.); Stinson, 944 F.2d at 1160 (3d Cir.). The Second Circuit has held, however, that “collateral research and investigations ... do[ ] not establish ‘direct and independent knowledge of the information on which the allegations are based,’ ” Kreindler, 985 F.2d at 1159. Similarly, other Courts have held that information obtained from third parties, such as coworkers, is neither direct nor independent. See, e.g., Fine, 99 F.3d at 1007; Hays, 325 F.3d at 991; United States ex rel. Holmes v. Consumer Ins. Group, 318 F.3d 1199, 1207 (10th Cir.2003) (characterizing a “parasitic qui tam action” as one “based on knowledge obtained secondhand through other employees”). This would suggest that an inquiry which confirmed information otherwise obtained is not sufficient to constitute plaintiff as an original source. If, as Defendant claims, Relator’s information came from another source and he confirmed it by independent investigation, he cannot claim, after the fact, that he was an original source. Based on the evidence presented thus far, this Court finds that Relator was not an original source as to the information presented in paragraphs 83-88 of the Second Amended Complaint and therefore, the Court does not have subject matter jurisdiction over those allegations. D. Information and Belief Allegations Defendant argues that the allegations pled “on information and belief’— specifically, those found in paragraphs 20, 69, 72, 77-78, 82-83 and 87-88 of the Second Amended Complaint — should be dismissed. Defendant claims that as to those allegations, Relator “has no basis to claim original source status.” Def.’s Reply at 10. Even if allegations are filed “on information and belief,” however, a relator can qualify as an original source if he or she had independent, firsthand knowledge of fraudulent conduct before the allegations of fraud were publicly disclosed. See United States ex rel. DeCarlo v. Kiewit/AFC Enters., 937 F.Supp. 1039, 1049 (S.D.N.Y.1996) (holding that DeCarlo, who was employed to work with the defendant on a specific project and who had “independent knowledge of [the defendant’s] allegedly fraudulent conduct, obtaining information and making firsthand observations during the course of his employment on the Project”, “is the type of plaintiff envisioned by the qui tam provisions of the False Claims Act.”). If Relator actually observed the allegedly fraudulent acts or conduct that he has described as of information and belief, he would still have direct, i.e., personal, knowledge. If, on the other hand, Relator infers acts or conduct based on sources of information other than his personal observations, his claims would not be based on direct, personal knowledge. In his Affidavit, Relator outlines the “core” information he observed during his tenure at YNHH. Opp’n, Exh. A ¶¶ 13-22. Relator alleges to have direct knowledge of, inter alia, the resident schedules, the procedures for reviewing interpretations and associated images and finalizing reports, the alleged practice of some of the Emergency Department (“ED”) faculty members of not reviewing the images or the interpretations of the ED radiology tests, the alleged discovery that many of these reports were signed in large batches in a very short period of time while films were still in the library, the fact that this was contrary to long-standing policies in the ED, Yale’s “long standing practice” of automatically submitting claims for reimbursement for the Professional Component of all radiology tests and procedures that have been signed by faculty and placed in “F” status in the DecRad system (indicating that they had been finalized even though Relator alleges that many were never properly reviewed and corrected), the fact that Dr. Glickman’s name was used to finalize reports that allegedly had never been reviewed or edited, the Auto-sign fraud and YNNH’s “long standing practice” of automatically submitting claims for the Technical Component of radiology tests and procedures once the exam is placed in “C” status in the DecRad system even if such tests and procedures were only finalized by Autosign. Id. Some of Relator’s concerns regarding the practice of signing radiology reports on patient studies for which the films have been lost are indicated in a May 4,1998 memo Relator sent to Dr. Bruce McClennan, which Relator attaches as evidence of his direct knowledge of the fraud. See Opp’n Exh. B. As a recipient of the Tencza memo explaining Autosign, Relator clearly had direct knowledge of how Autosign was going to be used, see Opp’n Exh. C, but did not necessarily have direct knowledge that fraud was actually committed. Moreover, some of Relator’s knowledge — regarding, for example, the fraudulent finalization of preliminary reports written by Residents and Fellows and the Clean up project— stems from discussions with Residents and faculty members and his own independent investigations, which, as stated earlier, renders the information “indirect.” The knowledge at issue was not “unmediated by anything but [Relator’s] own labor” and was not derived from information obtained firsthand through relator’s own labor, rather, much of it was obtained secondhand, through reports from Residents, other faculty members and possibly, information produced during discovery in the State Court Action. Many of the claims pled on information and belief make up the substance of Relator’s FCA claim. See, e.g., 2d Am. Compl. ¶¶ 77 (“On information and belief, Defendants Yale and YNHH billed Medicare and Medicaid for the Professional Component of these Radiological Studies never reviewed by a Qualified Radiologist.”); 78 (“Upon information and belief, Defendants utilized the ‘Autosign’ process and the other afore-described non-Qualified Radiologist Radiology Study report finalization methods to avoid and conceal the obligation of said Defendants to repay the United States monies paid to Yale and YNHH for both the Professional and Technical Components of these Radiological Services.”); 83 (“Upon information and belief, over a one-year period, from on or about July 1997 to July 1998, several thousands of Radiology Reports read by Residents and first year Neuroradiology Fellows were fraudulently finalized by Yale Faculty who never reviewed the images.”); 87 (“Upon information and belief, several thousands of such instances of fraud were perpetrated from July 1997 to July 1998.”). These allegations cannot survive without proof that Relator has direct, independent, firsthand knowledge of the information that does form the basis of the complaint and certainly cannot support an FCA claim. To be an original source, Relator must have direct and independent knowledge of facts, not mere suspicions of illegal conduct. Relator has not demonstrated that any of the alleged failures — i.e., the non-review by a qualified radiologist, billing for non-reviewed studies, finaliza