Neighorn v. Quest Health Care

870 F. Supp. 2d 1069, 2012 U.S. Dist. LEXIS 62288, 2012 WL 1566176
CourtDistrict Court, D. Oregon
DecidedMay 2, 2012
DocketCase No. 1:10-cv-03105-CL
StatusPublished
Cited by20 cases

This text of 870 F. Supp. 2d 1069 (Neighorn v. Quest Health Care) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Neighorn v. Quest Health Care, 870 F. Supp. 2d 1069, 2012 U.S. Dist. LEXIS 62288, 2012 WL 1566176 (D. Or. 2012).

Opinion

ORDER

CLARKE, United States Magistrate Judge.

This matter comes before the court on defendants’ motion (# 40) for summary judgment. For the reasons stated below, [1075]*1075the motion is granted in part and denied in part.

BACKGROUND

Plaintiff John Neighorn (“Neighorn”) filed this action on September 30, 2011, against defendants Quest Health Care (“Quest”) and Rotech Healthcare, Inc. (“Rotech”) (collectively, “Rotech”)1 alleging claims for retaliatory discharge in violation of the False Claims Act (“FCA”), 31 U.S.C. § 3729, et seq., and Oregon’s whistleblower statute ORS § 659A.199; violation of ORS § 652.750 for failing to provide him a copy of his personnel file; and a claim for common law wrongful discharge.

I. Rotech

As its primary business, Rotech provides respiratory services, including the delivery of oxygen to patients’ homes and the set up and maintenance of related equipment, as well as products and services for sleep apnea, such as CPAP and BiPAP devices. (Am. Compl., Dckt. # 72, ¶ 3; Defs’ Corrected Mem. Supp. Mot. Summ. J. (“Defs’ Corr. Mem.”), Dckt. # 51, pp. 2). Rotech provides these services to both private patients and patients whose care is paid for by the Department of Veterans Affairs (“VA”) and the Centers for Medicare & Medicaid Services (“CMS”), an agency of the Department of Health and Human Services (“DHHS”). (Defs’ Corr. Mem., pp. 2). Rotech delivers its services through approximately 3,500 employees operating out of 450 locations in 48 states, including its office in Central Point, Oregon. (Am. Compl., ¶ 3; Pi’s Mem. Opp’n Defs’ Mot. Summ. J., Dckt. # 53, pp. 3).

A. The May 2008 Corporate Integrity Agreement

On April 6, 2004, a qui tarn action was filed against Rotech in the United States District Court for the Eastern District of Texas, Texarkana Division, United States of America ex rel. Sheila Bell-Messier v. Ro-Tech Healthcare, Inc., et al., Civil Action No. 5:04-cv-0075. (Deck Stephani L. Ayers (“Ayers Deck”), Ex. 1, Dckt. # 54-7, pp. 2, & Ex. 2, Dckt. # 54-8). The Complaint alleged Rotech committed multiple ongoing violations of the FCA between February 22, 1996, and April 30, 2003, by fraudulently billing the government for durable medical equipment (“DME”) including respiratory devices; and further that Rotech fraudulently concealed these billing practices from the government in violation of a Corporate Integrity Agreement (“CIA”) entered into as the result of a 2002 settlement with the government for other compliance issues. (Id., Ex. 1, Dckt. # 54-7, pp. 2, & Ex. 2, Dckt. # 54-8, pp. 6-7). In particular, the Complaint alleged Rotech failed to follow “[t]he proper procedures necessary to receive compensation for DME from Medicare,” including, in relevant part, the failure to obtain and retain delivery tickets signed by the patient evidencing delivery and receipt of the DME. (Id., Ex. 2, Dckt. # 54-8, pp. 4-5).

On May 19, 2008, Rotech, without admitting any wrongdoing, entered into a settlement agreement with the government regarding the April 2004 qui tarn action and contemporaneously entered into another CIA with the Office of the Inspector General (“OIG”) of the United States Department of Health and Human Services (“DHHS”). (Ayers Deck, Ex. 1, Dckt. # 54-7, pp. 2-3). The CIA requires that Rotech “promote compliance with the statutes, regulations, and written directives of [1076]*1076Medicare, Medicaid, and all other Federal health care programs,” (id, pp. 3), through compliance management and oversight, written standards, training and education, review procedures, a disclosure program, screening and removal of ineligible persons, and reporting, (id, pp. 4-18).

As part of compliance management and oversight, the CIA requires that Rotech “continue to develop, implement and distribute a written Code of Conduct” stating Rotech’s commitment to non-retaliation and its requirement that all owners, officers, directors, and employees (“Covered Persons”) comply with all federal health care program requirements and Rotech policies and procedures, and report all “suspected violations” to its Compliance department. (I'd, pp. 3, 6-7). The CIA further requires that Rotech “continue to maintain and implement” written policies and procedures addressing, in relevant part, all applicable federal health care program requirements governing coverage and reimbursement of oxygen and the proper documentation necessary for the submission and reimbursement of claims, as well as the expectation that all Covered Persons comply with Rotech’s Code of Conduct, policies, procedures, and the CIA itself. (I'd, pp. 8).

As part of training and education, the CIA requires that Rotech describe its compliance program and provide all covered persons involved in billing, coding and claims submission, or the preparation or completion of documentation to support claims for reimbursement with annual training on “the federal health care program requirements governing coverage and reimbursement of oxygen, the proper completion of documentation necessary to support the reimbursement of claims; the personal obligation of each individual involved in the claims submission process to ensure that such claims are accurate; ... [and] examples of proper and . improper claims submission practices.” (I'd, pp. 4, 9-10). The CIA requires that Rotech retain all documents and records relating to reimbursement from Federal health care programs and compliance with the CIA for at least six years. (Id, pp. 25).

As part of review procedures, the CIA requires that Rotech retain an independent review organization (“IRO”) to, among other things, conduct annual claims review of 50 paid claims, and to repay any overpayment identified as a part of that review. (Id, pp. 11-12). Overpayment is defined as “the amount of money Rotech has received in excess of the amount due and payable under any Federal health care program requirements.” (Id, pp. 16). The definitions and procedures for the Claims Review process are documented in Appendix B of the CIA. (Id, pp. 38-43). Appendix B provides, at Section A, subsection 5(a), provides that “any Paid Claim for which Rotech cannot produce documentation sufficient to support the Paid Claim shall be considered an error and the total reimbursement received by Rotech for such Paid Claim shall be deemed an Overpayment.” (Id, pp. 40).

As a part of reporting, the CIA requires Rotech to notify OIG in writing within 30 days of identifying any reportable event. (Id at 18). “Reportable event” is defined to include both isolated and recurring instances of substantial overpayment as well as “a matter that a reasonable person would consider a probable violation of criminal, civil or administrative laws applicable to any Federal health care program for which penalties or exclusion may be authorized.” (Id, pp. 17).

The CIA provides certain stipulated monetary penalties in the event that Rotech fails to comply with its obligations. (Id, pp. 26-27). The CIA further provides that a failure by Rotech to report a Reportable Event, take corrective action, and [1077]

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870 F. Supp. 2d 1069, 2012 U.S. Dist. LEXIS 62288, 2012 WL 1566176, Counsel Stack Legal Research, https://law.counselstack.com/opinion/neighorn-v-quest-health-care-ord-2012.