Commonwealth v. S. Bay Mental Health Ctr., Inc.

334 F. Supp. 3d 394
CourtDistrict Court, District of Columbia
DecidedSeptember 21, 2018
DocketCivil Action No. 15-13065-PBS
StatusPublished
Cited by6 cases

This text of 334 F. Supp. 3d 394 (Commonwealth v. S. Bay Mental Health Ctr., Inc.) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Commonwealth v. S. Bay Mental Health Ctr., Inc., 334 F. Supp. 3d 394 (D.D.C. 2018).

Opinion

Saris, C.J.

*398INTRODUCTION

The Commonwealth of Massachusetts brings this action against South Bay Mental Health Center, Inc. ("South Bay"), and others to recover payments made by the Massachusetts Medicaid program ("MassHealth") as a result of allegedly false claims submitted to MassHealth from August 2009 to the present. The other defendants are Community Intervention Services, Inc. ("C.I.S."), and Community Intervention Services Holdings, Inc. ("C.I.S.H."); H.I.G. Growth Partners, LLC, and H.I.G. Capital, LLC (collectively, "H.I.G. Defendants"); Peter J. Scanlon; and Kevin P. Sheehan. The core allegation is that Defendants submitted claims for services of "unlicensed, unqualified, and unsupervised personnel" in violation of MassHealth regulations at 17 South Bay mental-health centers.

The Commonwealth's 27-count Complaint-in-Intervention ("the Complaint") contains 368 paragraphs and multiple exhibits alleging false claims in violation of state law, regulations, and common law. It asserts claims under the Massachusetts False Claims Act ("MFCA"), Mass. Gen. Laws ch. 12, §§ 5A et seq. ; the Massachusetts Medicaid False Claims Act, Mass. Gen. Laws ch. 118E, §§ 40, 44 ; Recovery of Overpayment regulations, 130 Mass. Code Regs. §§ 450.237, 450.260(A), 450.260(I) ; Unjust Enrichment; and Breach of Contract. The Commonwealth asserts subject-matter jurisdiction over state-law claims arising from the same transactions or occurrences as an action brought under the federal False Claims Act ("FCA"). 31 U.S.C. § 3732(b).

In a separate complaint, Relator has brought claims under the FCA. The federal government has declined to intervene. Because the Relator's allegations, causes of action, and theories of recovery are different, her claims will be addressed in a separate opinion with which the Court assumes familiarity.

In February 2018, the Commonwealth reached an agreement to resolve its state-law claims against South Bay, C.I.S., and C.I.S.H., and dismissed them as Defendants. Accordingly, this memorandum focuses on the remaining 14 state-law counts against the H.I.G. Defendants and the individual Defendants, Scanlon and Sheehan.

The remaining Defendants have moved to dismiss on multiple grounds. After a hearing, the Court ALLOWS the motions as to Counts 13, 14, and 15 against the H.I.G. Defendants; Counts 18 and 20 against Scanlon; and Counts 23, 24, and 26 against Sheehan. The motions are otherwise DENIED.

FACTUAL BACKGROUND

The Complaint alleges the following facts, many of which are disputed. The Court must "accept the truth of all well-pleaded facts and draw all reasonable inferences therefrom in the pleader's favor." Grajales v. P.R. Ports Auth., 682 F.3d 40, 44 (1st Cir. 2012).

*399I. South Bay

South Bay, a MassHealth provider, operates 17 mental-health centers in Massachusetts, which are licensed by the Department of Public Health. South Bay was founded by Defendant Scanlon in 1986, and from then until April 12, 2012, he owned all outstanding capital stock. South Bay's Brockton Clinic is the parent mental-health center, at which most of the administrative, organizational, and clinical services are performed. The satellite facilities are in different locations, but operate under the license of the parent and fall under its fiscal, administrative, and personnel management.

South Bay submitted claims for mental-health counseling to MassHealth through the Massachusetts Behavioral Health Partnership ("MBHP"), which administers and pays mental health care plans for patients enrolled in the Primary Care Clinical Plan. Other patients are enrolled in Managed Care Organizations ("MCOs"), which contract with MassHealth to administer the payment of mental-health benefits. MassHealth also provides mental-health benefits on a fee-for-services basis. The MassHealth regulations governing the operations, staffing, licensing, and supervision requirements of mental-health centers are set out at 130 Mass. Code Regs. § 429.000, et seq.

II. The Private Equity Investors

Defendants H.I.G. Growth, LLC, and its capital investment affiliate, H.I.G. Capital, LLC, are Delaware limited liability companies. The H.I.G. entities and Defendant Sheehan partnered to acquire South Bay. They established layers of corporations to accomplish this purchase. Scanlon sold his capital stock in South Bay to C.I.S., a Delaware corporation, and received a cash payment, common stock, and a promissory note, together worth over $31 million. C.I.S.H., a Delaware holding corporation, owns C.I.S., which owns South Bay. H.I.G. Growth owns 71.1 percent of C.I.S.H. Sheehan, who had over 30 years of behavioral health care experience and conducted "substantial due diligence" before purchasing C.I.S., became the Chief Executive Officer ("CEO") of C.I.S. until 2016, and Scanlon served as the Chief Clinical Officer until either 2013 or 2014. Scanlon was a member of the Boards of Directors of South Bay and C.I.S.

H.I.G.'s managing director and principals form the majority of the C.I.S. board that owns and operates South Bay. Nicholas Scola, Steven Loose, Eric Tencer, Sheehan, and Scanlon served on the five-member Board of Directors of C.I.S. Scola, Loose, and Tencer are principals or directors of H.I.G. Growth.1 The Board of Directors of C.I.S. "was aware of South Bay operating" and was "responsible for making strategic decisions" including "personnel changes," "financial matters," and evaluations of "specific long-term issues at South Bay" like "the struggle to recruit and retain clinicians."

III. The Whistleblower

Christine Martino-Fleming, the Relator, is a licensed mental-health counselor. She was employed by South Bay from June 2008 until September 2013. Initially, she was a Job Coach at South Bay, helping with documentation, billing, and time management. In March 2012, she was elevated to the Coordinator of Staff Development and Training position for C.I.S. Her duties included analyzing the education and experience *400of South Bay employees. She also was responsible for the clinical training of new clinicians and the managerial leadership training for supervisors, directors, and regional directors.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
334 F. Supp. 3d 394, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commonwealth-v-s-bay-mental-health-ctr-inc-dcd-2018.