Petrick v. Stars Bay Area, Inc

CourtDistrict Court, N.D. California
DecidedMarch 5, 2021
Docket5:19-cv-03105
StatusUnknown

This text of Petrick v. Stars Bay Area, Inc (Petrick v. Stars Bay Area, Inc) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Petrick v. Stars Bay Area, Inc, (N.D. Cal. 2021).

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 SAN JOSE DIVISION 7 8 KRISTEN PETRICK, et al., Case No. 19-cv-03105-VKD

9 Plaintiffs, ORDER GRANTING MOTION TO 10 v. DISMISS WITH LEAVE TO AMEND

11 STARS BAY AREA, INC, Re: Dkt. No. 29 Defendant. 12

13 14 Plaintiff-relator Kristen Petrick asserts the following claims against defendant Stars Bay 15 Area, Inc. (“Stars”) and Does 1-25 on behalf of the United States and the State of California1: (1) 16 violation of the False Claims Act (“FCA”), 31 U.S.C. § 3729 et seq.; (2) violation of the 17 California False Claims Act (“CFCA”), California Code § 12652 et seq.; and (3) violation of the 18 California Insurance Fraud Prevention Act, California Insurance Code § 1871.4. Dkt. No. 27. 19 Stars now moves to dismiss all claims under Federal Rules of Civil Procedure 12(b)(6) and 9(b). 20 Dkt. No. 29. 21 All parties except the Doe defendants2 have appeared and consented to magistrate judge 22 jurisdiction. Dkt. Nos. 4, 18, 21, 22. The Court finds this matter suitable for resolution without 23 oral argument. Civ. L.R. 7-1(b). Having considered the parties’ submissions, the Court grants 24 Stars’s motion to dismiss the amended complaint with leave to amend. 25 1 Both the United States and California have declined to intervene in this action. Dkt. No. 9. 26

2 Naming Doe defendants in a federal action is disfavored. Gillespie v. Civiletti, 629 F.2d 637, 27 642 (9th Cir. 1980). If this action proceeds past the pleading stage and information supporting the I. BACKGROUND3 1 Stars is a California corporation that provides therapy and counseling services to children. 2 Dkt. No. 27 ¶ 6. Stars bills patients and receives payment through both private insurance 3 companies and federal and state government-funded insurance programs, including Medicaid and 4 Medi-Cal. Id. 5 Ms. Petrick worked as a Board Certified Behavioral Analyst (“BCBA”) at Stars beginning 6 in October 2017. Id. ¶ 14. At some point, Stars promoted Ms. Petrick to Director of Operations. 7 Id. In that role, Ms. Petrick was required to “maintain accurate documentation of billable tasks 8 that meets the requirements of regulatory agencies and funding sources.” Id. ¶ 17. Using a 9 software program called Central Reach, Ms. Petrick had access to reports of services provided to 10 patients and corresponding billing codes. Id. ¶ 16. The Stars billing department used reports 11 generated from Central Reach to request payment from government-funded insurance programs 12 and from private insurance companies. Id. ¶ 18. 13 In reviewing Central Reach reports, Ms. Petrick observed that Stars employees known as 14 “leads” billed for certain services that only BCBAs could perform. Id. ¶¶ 19-20, 23. These 15 services included initial assessments, plan development, parent training, and supervision. Id. ¶¶ 16 20, 23. Additionally, she observed that leads billed for “support Parent Training.” Id. ¶ 19. The 17 amended complaint does not explain the duties and responsibilities of a “lead,” and does not 18 describe the educational or professional qualifications of the position, except to assert that “leads” 19 are not BCBAs and do not hold master’s degrees. See id. ¶¶ 19, 21, 26-30. 20 On January 19, 2018, Ms. Petrick inquired of someone called “Marysol”4 about the billing 21 requirements of private insurance companies and government-funded insurance programs. Id. ¶ 22 25. Ms. Petrick says the following leads (presumably, Stars employees, although the amended 23 complaint does not expressly say so) were directly assigned cases and performed services under 24 25 3 Unless otherwise noted, the following factual allegations are taken from the amended complaint, 26 and they are accepted as true for purposes of the motion to dismiss. See Reese v. BP Exploration (Alaska) Inc., 643 F.3d 681, 690 (9th Cir. 2011). 27 1 billing codes as follows:

2 • Crystal Malek: Parent Training (S5111) on January 2, 2018; Supervision (H0032) on 3 February 5, 2018; and Supervision (H0032) on February 6, 2018.

4 • Danae Medrano: Supervision (H0031) on January 31, 2018.

5 • Vanessa Diaz Winborn: Parent Training (H2019) on February 5, 2018 and February 9, 2018; Supervision (H0032) on January 31, 2018. 6

7 • Shabnam Razawi: Parent Training (H2019) on January 31, 2018. 8 Id. ¶¶ 27-30. 9 On March 8, 2018, Ms. Petrick raised concerns about improper billing with Stars’s Chief 10 Executive Officer. He informed her that Stars’s billing practices were “allowed.” Id. ¶ 31. Ms. 11 Petrick then contacted representatives of two insurance plans that service Medicaid and Medi-Cal 12 beneficiaries to inquire directly about their billing requirements, and they responded as to their 13 respective requirements. Id. ¶¶ 33-35. Believing Stars’s billing practices were improper, Ms. 14 Petrick proposed that Stars hire more BCBAs to perform services and/or supervise the work of 15 employees who were not BCBAs, and that Stars not permit leads to continue performing and 16 billing for certain services. Id. ¶ 41. Ms. Petrick says that when she continued to voice her 17 concerns to Stars management about what she believed to be improper billing practices, she was 18 “met with hostility, and told it was an acceptable billing practice.” Id. ¶ 40. Stars terminated Ms. 19 Petrick’s employment on October 28, 2018. Id. ¶¶ 37-38, 43. 20 Ms. Petrick alleges “based upon . . . information and belief,” that Stars knowingly 21 submitted false claims and records to the United States and the State of California in order to 22 obtain payments. Id. ¶ 39. She filed this action on June 4, 2019. Dkt. No. 1. Stars filed a motion 23 to dismiss, which was rendered moot when Ms. Petrick filed the operative amended complaint on 24 December 11, 2020. Dkt. Nos. 17, 27. The motion now before the Court followed. Dkt. No. 29. 25 II. LEGAL STANDARD 26 A. Rule 12(b)(6) 27 “A motion to dismiss under Federal Rule of Civil Procedure 12(b)(6) for failure to state a 1 Force v. Salazar, 646 F.3d 1240, 1241–42 (9th Cir. 2011) (quoting Navarro v. Block, 250 F.3d 2 729, 732 (9th Cir. 2001)). When determining whether a claim has been stated, the Court accepts 3 as true all well-pled factual allegations and construes them in the light most favorable to the 4 plaintiff. Reese v. BP Exploration (Alaska) Inc., 643 F.3d 681, 690 (9th Cir. 2011). While a 5 complaint need not contain detailed factual allegations, it “must contain sufficient factual matter, 6 accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 7 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). A claim is 8 facially plausible when it “allows the court to draw the reasonable inference that the defendant is 9 liable for the misconduct alleged.” Id. 10 Documents appended to the complaint, incorporated by reference in the complaint, or 11 which properly are the subject of judicial notice may be considered along with the complaint when 12 deciding a Rule 12(b)(6) motion. Khoja v. Orexigen Therapeutics, 899 F.3d 988, 998 (9th Cir.

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Petrick v. Stars Bay Area, Inc, Counsel Stack Legal Research, https://law.counselstack.com/opinion/petrick-v-stars-bay-area-inc-cand-2021.