Horsley v. Comfort Care Home Health LLC

CourtDistrict Court, N.D. Alabama
DecidedJuly 15, 2020
Docket2:19-cv-00229
StatusUnknown

This text of Horsley v. Comfort Care Home Health LLC (Horsley v. Comfort Care Home Health LLC) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Horsley v. Comfort Care Home Health LLC, (N.D. Ala. 2020).

Opinion

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ALABAMA SOUTHERN DIVISION

UNITED STATES OF AMERICA, } ex rel. ERIN HORSLEY, } } Plaintiffs, } } v. } Case No.: 2:19-CV-00229-RDP } COMFORT CARE HOME HEALTH, } LLC; et al., } } Defendants. }

MEMORANDUM OPINION

This case involves a qui tam action filed by Plaintiff-Relator Erin Horsley (“Relator” or “Horsley”) against Defendants Comfort Care Home Health, LLC, Woodland Home Health Services-CRMC, LLC, Trilogy Physical Services, LLC, Jonathan James, Alan Stewart, and Steve Carmen. (See Doc. # 1). She asserts claims under the False Claims Act. See 31 U.S.C. § 3729. Horsley originally filed this action, but the United States thereafter intervened pursuant to its authority under 31 U.S.C. § 3730(c)(2). After doing so, it reached a proposed settlement with Defendants, and has now filed two motions: one asking the court to find the proposed settlement is fair, adequate, and reasonable (Doc. # 21); and the other seeking dismissal of all unreleased claims (Doc. # 22). Horsley opposes the motions. The motions are fully briefed (Docs. # 26, 27, 32). After careful consideration, the court concludes that both motions (Docs. # 21, 22) are due to be granted. I. Background This case stems from claims that several home health care companies engaged in Medicare fraud. Because the procedural history of this case is complex, the court has divided the “Background” portion of this opinion into three sections. The court first reviews the legal background of this case, including an overview of the False Claims Act and the relevant Medicare

reimbursement processes applicable to home health care companies. The court then discusses the factual background of this case, including the parties’ relationships with one another. Finally, the court details the relevant procedural background of this action, beginning with the filing of Plaintiff-Relator’s complaint through the government’s decision to intervene and eventually settle the case with Defendants. A. Legal Background The False Claims Act (“FCA”) is a federal statute that prohibits any individual or entity from knowingly submitting a false or fraudulent claim to the government for compensation or approval, or knowingly making, using, or causing to be made or used, a false record or statement

that is material to a false or fraudulent claim. See 31 U.S.C. §§ 3729(a)(1), 3729(a)(1)(A)-(B). The FCA also forbids anyone from concealing or circumventing any obligation to remit money back to the federal government. 31 U.S.C. § 3729(a)(1)(G). The terms “knowing” or “knowingly” are defined in the Act and they cover any individual who, with regards to material information: “(i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information.” 31 U.S.C. § 3729(b). Recognizing that the government will not always be able to detect or protect against fraud, Congress authorized private parties to bring claims on behalf of the government. “In a qui tam action, [a] relator pursues the government’s claim against the defendant, and asserts the injury in face suffered by the government.” United States ex rel., Farmer v. Honduras, No. 17-00470-KD- N, 2020 WL 496509, at *5-6 (S.D. Ala. Jan. 30, 2020) (internal quotation marks and citations omitted), appeal docketed, United States v. McAvoy, No. 20-10604 (11th Cir. Feb. 18, 2020). The United States remains the real party in interest. United States v. Everglades Coll., Inc., 855 F.3d

1279, 1289 (11th Cir. 2017). “In bringing a qui tam action the relator in effect su[es] as a partial assignee of the United States.” Id. (bracketed text in original). “If the United States decides to intervene, the government acquires ‘primary responsibility for prosecuting the action,’ although the relator remains a party” to the action. United States ex rel. Hunt v. Cochise Consultancy, Inc., 887 F.3d 1081, 1086-87 (11th Cir. 2018) (internal quotation marks and citations omitted), cert. granted sub nom. Cochise Consultancy, Inc. v. U.S. ex rel. Hunt, 139 S. Ct. 566 (2018), aff’d, 139 S. Ct. 1507 (2019). Relevant to this action, the government (as part of the Medicare program) will pay for certain home health services, including part-time or intermittent skilled nursing care, speech-

language pathology, physical or occupational therapy, part-time or intermittent skilled home health-aid services, and medical social services. See 42 U.S.C. §§ 1395d(a)(3), 1395k(a)(2)(A), 1395x(m). To receive Medicare reimbursement, when creating a patient’s plan of treatment, a physician must also certify that the patient meets a certain set of coverage requirements. 42 C.F.R. § 424.22. That is, the physician must certify that: (1) the patient needs the particular type of home health service; (2) the patient was non-ambulatory or homebound (except when receiving outpatient services) and therefore needs the home health service; (3) the patient’s treatment plan for home health services has been established and will be periodically reviewed by a licensed physician; and (4) that the home health service was administered to the patient while under the care of a licensed physician. See 42 C.F.R. §§ 424.22(d), 424.22(a)(1); see also 42 U.S.C. § 1395n(a). Additionally, the physician reviewing the patient’s treatment plan must recertify every sixty-days that the patient still needs the home health services, and must provide an as to estimate how much longer the patient will require the services. See 42 C.F.R. § 424.22(b)(1)-(2). If the home health agency transfers or discharges a patient, and the patient returns to the same home

health agency, recertification must occur during the first sixty days. See 42 C.F.R. § 424.22(b)(1). B. Factual Background Defendant Comfort Care Home Health, LLC (“Comfort Care”) manages a number of home health agencies in Alabama including Defendant Woodland Home Health Services-CRMC, LLC (“Woodland”). (Doc. # 26 at ¶ 2). Comfort Care is also a partial owner of Woodland. (Id.). Trilogy Physician Services, LLC (“Trilogy”) provides physician home visits for non-ambulatory patients. (Doc. # 26 at ¶ 4). Defendant Alan Stewart (“Stewart”) was a partial founder and owner of Trilogy. (Id.). In 2017, he sold his ownership interest in Trilogy and was named COO of Comfort Care. (Id.). Defendant Steven Carman (“Carman”) is a regional administrator of Comfort Care, and

Defendant Jonathan James (“James”) is the agency administrator of Woodland. (Doc. # 26 at ¶ 2).

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

Related

Ridenour v. Kaiser-Hill Co.
397 F.3d 925 (Tenth Circuit, 2005)
Swift, Susan v. United States
318 F.3d 250 (D.C. Circuit, 2003)
USA v. Everglades College, Inc.
855 F.3d 1279 (Eleventh Circuit, 2017)
United States Ex Rel. Hunt v. Cochise Consultancy, Inc.
887 F.3d 1081 (Eleventh Circuit, 2018)
United States v. Aseracare, Inc.
938 F.3d 1278 (Eleventh Circuit, 2019)
Weih Chang v. Childrens Advocacy Center of D
938 F.3d 384 (Third Circuit, 2019)

Cite This Page — Counsel Stack

Bluebook (online)
Horsley v. Comfort Care Home Health LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/horsley-v-comfort-care-home-health-llc-alnd-2020.