MARGARET GATHMAN v. CARE ONE MANAGEMENT, LLC (L-5015-17, BERGEN COUNTY AND STATEWIDE)

New Jersey Superior Court Appellate Division·Decided February 22, 2022·No. A-2904-19·Unpublished

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION

DOCKET NO. A-2904-19

MARGARET GATHMAN, Plaintiff-Appellant,

v.

CARE ONE MANAGEMENT, LLC, ELIZABETH STRAUS, and THOMAS MCKINNEY,

Defendants-Respondents.

Argued December 15, 2021 – Decided February 22, 2022 Before Judges Sumners and Firko.

On appeal from the Superior Court of New Jersey, Law Division, Bergen County, Docket No. L-5015-17.

R. Armen McOmber argued the cause for appellant (McOmber McOmber & Luber, PC, attorneys; Lauren M. Hill, of counsel and on the briefs; Peter D.

Valenzano and R. Armen McOmber, on the briefs).

Michael J. Dee argued the cause for respondents (O'Toole Scrivo, LLC, attorneys; Thomas P. Scrivo and Michael J. Dee, of counsel; Nicole M. DeMuro, on the brief).

PER CURIAM Plaintiff Margaret Gathman appeals the Law Division's summary judgment order dismissing with prejudice her first amended complaint alleging that defendants Care One Management, LLC (Care One), Thomas A. McKinney, and Elizabeth Straus terminated her employment in violation of the Conscientious Employee Protection Act (CEPA), N.J.S.A. 34:19-1 to -14, and common law under Pierce v. Ortho Pharm. Corp., 84 N.J. 58 (1980). We reverse and remand for trial because we agree with Gathman that there are genuine issues of material facts regarding the reasons for her termination, and that she can decide prior to trial whether she wants to pursue her CEPA or Pierce claim.

I

In this appeal, our recitation of the facts is derived from the evidence submitted by the parties in support of, and in opposition to, the summary judgment motion, viewed in the light most favorable to the non-moving party, Gathman, and giving her the benefit of all favorable inferences. Globe Motor Co. v. Igdalev, 225 N.J. 469, 479 (2016) (citing R. 4:46-2(c)).

Care One is a management company providing services to various post-acute nursing and assisted living facilities on the east coast, including approximately thirty facilities in New Jersey. Gathman was initially employed A-2904-19

by Care One in 2005, as a Regional Business Office Manager. After rising to the position of Assistant Regional Controller, she resigned for personal reasons in July 2012.

In the spring of 2015, Gathman was contacted by Care One's Chief Strategy Officer, Timothy Hodges, about meeting with Straus, Care One's Executive Vice President, to discuss returning to the company. According to her, Hodges sought her out because of her past "success[] turn[ing] facilities around and collect[ing] the monies that the company needed to operate, put[ting] systems in place[,] and [doing] training on a broad scale." After meeting with company executives, Straus, Michael Shea, Controller, Daniel Straus, Chairman and Chief Executive Officer, and Alberto Lugo, Executive Vice President and General Counsel, Gathman returned to Care One as Director of the Shared Business Office on August 19, 2015.

A month or so later, Gathman discovered the company was exposed to liability for violating the law by not returning overpayments. She discovered that overpayments and security deposits owed to Medicare, Medicaid, and other entities and individuals for residents who died were overdue. In one case, she determined that $50,000 in a resident's personal needs checking account in one of their facilities was illegally retained for over a year after the resident died.

A-2904-19

Although funds needed to be returned, she believed it was not a "number one priority" at the time because she was more focused on the "tremendous amount of outstanding receivables."

A couple of months later, Gathman determined she had to give attention to refunding overpayment as well as improving the collection of money owed to Care One. The failure to return overpayments to the federal government posed a liability to the company under Section 1128J(d) of the Patient Protection and Affordable Care Act, 124 Stat. 119 (2010).1 In January, February, and March of 2016, Gathman issued reports regarding the extent of the unreturned overpayments and liability to her supervisor, Shea. During a meeting, Shea stated that Care One's management team would not be pleased about this problem, and she should create a plan––without having to hire additional staff– –to tackle the issue before presenting it to management. According to Gathman,

1 Section 1128J(d) of the Affordable Care Act, which took effect on March 23, 2010, requires a person who "has received an overpayment" from the federal government to report and return the overpayment and to provide, in writing, a reason for the overpayment. 42 U.S.C. § 1320a-7k(d)(1). The overpayment must be reported and returned within sixty days after the date on which the overpayment is "identified" or, if applicable, the date any corresponding cost report is due, whichever is later. Id. § 1320a-7k(d)(2). The requirement to report and return an overpayment within this deadline is defined as "an obligation" within the meaning of the False Claims Act, 31 U.S.C. §§ 3729-3733. Id. § 1320a-7k(d)(3).

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she kept senior management, including Straus and Lugo, abreast of her progress on the retained funds via monthly meetings and written progress reports, and expressed concern over the company's non-compliance in returning them, estimated to be as much as $13 million with further investigation needed to settle the actual amount.

In April 2016, Shea was terminated from Care One. Lugo, who informed Gathman that Shea's termination had "to do with th[e] whole credit mess[,]" stated she would now report to him and Straus.

On August 4, Straus advised Gathman that she was being considered for the position of Vice President of Finance. The day before, Gathman emailed McKinney, Lugo, Straus, Hodges, and others a report (August 3 report) providing that she had returned "large sums of money," identified as "true credits" owed to Medicare, Medicaid, individuals, and entities, which were unlawfully held by Care One. Credits totaling approximately $3 million had been returned in the first six months of 2016, roughly $500,000 a month. Because Care One's monthly revenue for New Jersey facilities was roughly $30 to $32 million a month, Gathman believed returning the owed funds at that rate would not "have a drastic impact on [the company's] cash flow [and] it would help [the company] to get compliant within a year, year and a half."

A-2904-19

On August 12, 2016, McKinney, Senior Vice President and Deputy General Counsel, delivered a letter––signed only by him—to Gathman stating she was terminated that day because "of certain things that have come to light recently, the organization has lost confidence in [her] ability to effectively perform in [her] role" and her position was eliminated due to restructuring. In a meeting with McKinney and Christina Lopez from Human Resources, Gathman claimed she was told Straus made the decision to terminate her. Straus, however, deposed that she did not know Gathman and was not involved in terminations. McKinney deposed that it was Lugo who made the decision to terminate Gathman, but in speaking to Lugo about the action, he did not specify the performance issues "the organization" had with her or why her position was being eliminated.

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