Raney v. Amedisys Inc

CourtDistrict Court, N.D. Alabama
DecidedSeptember 29, 2021
Docket2:19-cv-01269
StatusUnknown

This text of Raney v. Amedisys Inc (Raney v. Amedisys Inc) 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
Raney v. Amedisys Inc, (N.D. Ala. 2021).

Opinion

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

UNITED STATES OF AMERICA ) ex rel. HEATHER RANEY, ) ) Plaintiff, ) ) Civil Action No. v. ) 2:19-CV-01269-AKK ) AMEDISYS, INC. and ) AMEDISYS HOME HEALTH OF ) ALABAMA, LLC, )

) Defendants.

MEMORANDUM OPINION Heather Raney filed this suit against Amedisys, Inc. and Amedisys Home Health of Alabama, LLC, pleading four False Claims Act violations stemming from the defendants’ alleged fraudulent billing to Medicare. Specifically, Raney alleged the defendants falsified patient information and evaluations so their care would qualify for Medicare reimbursement. See doc. 3. Raney also pleaded that the defendants discharged her in retaliation for reporting and attempting to stop conduct she perceived as fraudulent. Id. at 25. After the government declined to intervene, doc. 10, Raney gave notice of her voluntary dismissal of the three FCA counts of false claims, reverse false claims, and conspiracy. Doc. 22. The court subsequently dismissed these counts, and only Raney’s retaliation claim remains. Id.; doc. 25. The court now has before it the defendants’ Rule 12(b)(6) motion to dismiss the retaliation claim for failure to state a claim upon which relief can be granted. Doc. 29. The motion is fully briefed, docs. 31–32, and due to be granted.

I. The Federal Rules of Civil Procedure require a pleading to contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” FED.

R. CIV. P. 8(a)(2).1 Though this does not require “detailed factual allegations,” it does demand “more than an unadorned, the-defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)). The complaint “must set forth ‘more than

labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.’” Christman v. Walsh, 416 F. App’x 841, 844 (11th Cir. 2011) (quoting Twombly, 550 U.S. at 555). “Nor does a complaint suffice if it tenders ‘naked

assertion[s]’ devoid of ‘further factual enhancement.’” Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 557).

1 Because Raney’s retaliation allegations do not depend on allegations of fraud, her complaint need only contain “a short and plain statement of the claim showing that [she is] entitled to relief” as described in this section. See United States ex rel. Sanchez v. Lymphatx, Inc., 596 F.3d 1300, 1304 (11th Cir. 2010) (“Sanchez’s allegations that she complained about the defendants’ ‘unlawful actions’ and warned them that they were ‘incurring significant criminal and civil liability’ would have been sufficient, if proven, to support a reasonable conclusion that the defendants were aware of the possibility of litigation under the False Claims Act. Because her retaliation claim did not depend on allegations of fraud, Sanchez’s complaint only needed ‘a short and plain statement of the claim showing that [she was] entitled to relief.’”). When a complaint fails to state a claim upon which a court may grant relief, the Federal Rules of Civil Procedure permit dismissal. FED. R. CIV. P. 12(b)(6). “To

survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Iqbal, 556 U.S. at 678. A complaint states a facially plausible claim for relief “when the

plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. Ultimately, this context- specific inquiry requires the court to “draw on its judicial experience and common sense” to determine whether the plaintiff has established “more than a sheer

possibility that a defendant has acted unlawfully.” Id. at 678–79. II.2 Amedisys, a home health and hospice care provider, hired Raney to serve as

a director of operations and an administrator for its Tuscaloosa, Alabama, and Fayette, Alabama, locations and as an administrator for the Brent, Alabama, location. Doc. 3 at ¶ 6. Amedisys tasked Raney with reviewing the evaluations of admitting nurses, whose intake would inform whether a particular patient was

2 As stated, the plaintiff’s allegations are presumed true for purposes of Rule 12(b)(6). See Grossman v. Nationsbank, N.A., 225 F.3d 1228, 1231 (11th Cir. 2000) (quoting GSW, Inc. v. Long Cty., 999 F.2d 1508, 1510 (11th Cir. 1993)) (“When considering a motion to dismiss, all facts set forth in the plaintiff’s complaint ‘are to be accepted as true and the court limits its consideration to the pleadings and exhibits attached thereto.’”). Accordingly, this section recounts the facts as described in the plaintiff’s amended complaint, doc. 3. However, legal conclusions unsupported by factual allegations are not entitled to this presumption. See Iqbal, 556 U.S. at 662. qualified for “home health care,” and recommending whether the patient should therefore be admitted for Amedisys’ services. See id. ¶¶ 7, 10, 21.3 Raney also

supervised other healthcare-related services provided by Amedisys at its various Alabama locations. See id. ¶ 44. While performing these duties, Raney alleges she discovered Amedisys’

practices “were designed to fraudulently maximize billing to the United States by falsely representing the type and severity of patients’ medical conditions.” Id. ¶ 7. For example, four months after she started at Amedisys in 2017, Raney noticed that Amedisys provided education services to staff at three specialty care assisted living

facilities (“SCALFs”). Id. ¶ 44. Knowing Medicare would not cover the costs of these services, Raney ordered them to stop and reported the matter to Mike Brown, the area vice president of operations, and Kim Cramer, the regional psychiatric nurse

educator. Id. Allegedly, however, these services “were nevertheless billed to Medicare, and nothing was done to investigate the extent of these services performed and billed from other SCALFs.” Id. On two other occasions, Raney discharged two employees “when it became

apparent that they had not actually treated their patients.” Id. ¶ 34. Raney alleges

3 In order to qualify for home health care reimbursement under Medicare, a patient must, among other requirements, be “homebound,” meaning the patient “is generally confined to her home and the patient cannot leave home without ‘considerable and taxing effort.’” Id. ¶ 10 (citing 42 U.S.C. § 1395). that Amedisys “took no steps to rectify any improper billings for these patients,” even after she “report[ed] these matters” to Brown and Amedisys’ human resources

department. Id. Moreover, Raney states that Amedisys neither conducted investigations to learn the extent of potential billings to Medicare for unperformed services nor attempted to refund payments that Medicare may have wrongfully

reimbursed. Id. In 2018, Raney investigated a complaint from a patient that an employee failed to properly evaluate the patient. Id. ¶ 36.

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

Related

Keven J. Mack v. Augusta-Richmond County
148 F. App'x 894 (Eleventh Circuit, 2005)
Childree v. UAP/GA AG Chem, Inc.
92 F.3d 1140 (Eleventh Circuit, 1996)
Crowe v. Coleman
113 F.3d 1536 (Eleventh Circuit, 1997)
Thomas v. Cooper Lighting, Inc.
506 F.3d 1361 (Eleventh Circuit, 2007)
US EX REL. SANCHEZ v. Lymphatx, Inc.
596 F.3d 1300 (Eleventh Circuit, 2010)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
Natasha Williams v. Alpharetta Transfer Station, LLC
411 F. App'x 226 (Eleventh Circuit, 2011)
Stephen Grossman v. Nationsbank, N.A.
225 F.3d 1228 (Eleventh Circuit, 2000)
Pierson v. Orlando Regional Healthcare Systems, Inc.
619 F. Supp. 2d 1260 (M.D. Florida, 2009)
Christman v. Walsh
416 F. App'x 841 (Eleventh Circuit, 2011)
Jamie Nesbitt v. Candler County, Georgia
945 F.3d 1355 (Eleventh Circuit, 2020)
Dana Hickman v. Spirit of Athens, Alabama, Inc.
985 F.3d 1284 (Eleventh Circuit, 2021)
1-800-411-I.P. Holdings, LLC v. Georgia Injury Centers, LLC
71 F. Supp. 3d 1325 (S.D. Florida, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
Raney v. Amedisys Inc, Counsel Stack Legal Research, https://law.counselstack.com/opinion/raney-v-amedisys-inc-alnd-2021.