Pack v. Hickey

Court of Appeals for the Tenth Circuit·Decided June 11, 2019·No. 18-8035·Unpublished

Opinion

FILED

United States Court of Appeals UNITED STATES COURT OF APPEALS Tenth Circuit

FOR THE TENTH CIRCUIT June 11, 2019

Elisabeth A. Shumaker

Clerk of Court

ROY PACK,

Plaintiff - Appellant,

v. No. 18-8035 (D.C. No. 1:15-CV-00185-NDF)

MAUREEN HICKEY; CLOUDPEAK (D. Wyo.) INITIATIVES, INC.,

Defendants - Appellees.

ORDER AND JUDGMENT*

Before BRISCOE, BALDOCK, and BACHARACH, Circuit Judges.

Plaintiff Roy Pack appeals the district court’s grant of summary judgment and related orders in favor of Defendants Maureen Hickey and Cloud Peak Initiatives, Inc. on Pack’s claims under the False Claims Act (FCA), 31 U.S.C. §§ 3729-3733. Exercising jurisdiction under 28 U.S.C. § 1291,1 we affirm.

*

After examining the briefs and appellate record, this panel has determined unanimously to honor the parties’ request for a decision on the briefs without oral argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore submitted without oral argument. This order and judgment is not binding precedent, except under the doctrines of law of the case, res judicata, and collateral estoppel. It may be cited, however, for its persuasive value consistent with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.

1 We initially questioned whether we had appellate jurisdiction. Specifically, after dismissing one of Defendants’ counterclaims with prejudice and granting summary judgment in favor of Defendants, the district court, following a stipulation by the parties, dismissed Defendants’ remaining counterclaims without prejudice. As

I. Background

In 2002, Pack founded Cloud Peak, a private mental health services facility in Sheridan, Wyoming. Pack and Hickey, who were in a romantic relationship, incorporated Cloud Peak in 2005, and for the next eight years, Hickey served as Cloud Peak’s President, owner, and sole shareholder and Pack as its CEO. In February 2013, Hickey terminated Pack’s employment as well as their romantic relationship and assumed control over property that Pack asserted was either his personal property or joint property. In response, Pack remotely seized control of Cloud Peak’s electronic records system, prompting Cloud Peak to seek and obtain an injunction against Pack.

While Pack and Hickey traded volleys in state court, including in a child custody action, Pack contacted Wyoming state regulatory authorities and alleged Hickey and Cloud Peak engaged in Medicaid fraud. After investigating the allegation, the Medicaid Fraud Control Unit of the Wyoming Attorney General’s Office elected not to pursue criminal charges but referred the matter to Wyoming Medicaid for possible administration action. Wyoming Medicaid initially penalized

such, when Pack filed his notice of appeal following the denial of his motion for reconsideration and the granting of Defendants’ motion for attorneys’ fees, there was not a final judgment. See Heimann v. Snead, 133 F.3d 767, 769 (10th Cir. 1998). In response to this court’s jurisdictional inquiry, Pack filed a motion in the district court seeking certification of a partial final judgment. See Fed. R. App. P. 54(b). The district court granted the motion, and accordingly, we have jurisdiction. See Lewis v. B.F. Goodrich Co., 850 F.2d 641, 645 (10th Cir. 1988) (“[I]f the appellant obtains a 54(b) certification after the notice of appeal was filed, we will deem the notice of appeal to ripen as of the date of certification and will accept the jurisdiction[.]”).

Cloud Peak $349,893.11 for lack of adequate documentation and failing to respond to records requests. After Cloud Peak produced additional records, Wyoming Medicaid reduced the penalty to $71,705.97, and Cloud Peak paid the penalty.

Thereafter, in October 2015, Pack initiated this FCA qui tam action2 against Defendants. Pack alleged that Hickey was the sole person responsible for reviewing and submitting bills to Medicaid and that she committed Medicaid fraud based upon three types of false billing.

First, Pack alleged Defendants billed a skills group as a therapy group.

Specifically, Pack alleged that after David Peterson, a licensed therapist who supervised a therapy group, left Cloud Peak in September 2011, Hickey instructed Cloud Peak staff to continue that same group with Ryan Legler as its leader, even though Legler was not a licensed therapist. Pack alleged this treatment was billed as if Galin McGowan, a licensed therapist and clinical director for Cloud Peak, was supervising the group. Pack alleged Legler drafted the treatment notes and emailed them to McGowan, with McGowan then entering the notes into the electronic records system as though he wrote them. Pack further alleged McGowan never attended the sessions, including those held on Fridays, which all treating staff had off from work.

2 “Qui tam is short for ‘qui tam pro domino rege quam pro se ipso in hac parte sequitur,’ which means ‘who pursues this action on our Lord the King’s behalf as well as his own.’” Rockwell Int’l Corp. v. United States, 549 U.S. 457, 463 n.2 (2007). Under the FCA, either the government may initiate the action itself or, as in this case, a private party, known as a relator, may bring a qui tam suit in the government’s name. United States ex rel. Barrick v. Parker-Migliorini Int’l, LLC, 878 F.3d 1224, 1226 (10th Cir. 2017), cert. denied, 139 S. Ct. 78 (2018). Relators may receive 25 to 30 percent of a recovery. See 31 U.S.C. § 3730(d).

Pack, thus, alleged Legler effectively led a skills group, although Hickey billed it as a therapy group, thereby commanding a higher reimbursement rate.

Next, Pack alleged Defendants improperly billed group therapy sessions as individual therapy sessions. Specifically, Pack alleged that Hickey billed a group session conducted by therapist Roderick Foley as though Foley was conducting individual sessions for each of the group participants, thereby inflating the Medicaid reimbursement amount.

Finally, Pack alleged Defendants improperly billed for direct targeted case management services without documentation of medical necessity, insisting Hickey often would be seen leaving clients’ residences at the same time the assigned case manager was arriving to provide those services.

II. Discussion

On appeal, Pack contends the district court erred by: (1) refusing to grant his discovery request to copy Cloud Peak’s electronic records; (2) striking portions of his affidavit; (3) granting summary judgment for Defendants; (4) denying his motion for reconsideration; and (5) awarding attorneys’ fees to Defendants.

A. Discovery Order First, Pack contends the district court erred by refusing to order Defendants to submit to his discovery request to enter their property and copy Cloud Peak’s electronic records, including metadata. Pack sought such records in order to show whether, when, and what changes were made to those records before Defendants submitted them to the state regulatory authorities. In response, Defendants filed a

motion for a protective order, contending: (1) an injunction had been entered in state court preventing Pack from entering Defendants’ property or obtaining Cloud Peak’s data; (2) Pack already had backup copies of Cloud Peak’s electronic records, which were created during the time Pack had seized control of Cloud Peak’s electronic records system; and (3) Pack already had copies of the records Defendants provided to the state regulatory authorities, thereby allowing for a comparison to the backup copies in his possession.

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