SMITH v. IDEAL CONCEPTS, INC.

CourtDistrict Court, E.D. Pennsylvania
DecidedNovember 27, 2023
Docket5:23-cv-02166
StatusUnknown

This text of SMITH v. IDEAL CONCEPTS, INC. (SMITH v. IDEAL CONCEPTS, INC.) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SMITH v. IDEAL CONCEPTS, INC., (E.D. Pa. 2023).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA _____________________________________

MICHAEL SMITH, : Plaintiff, : : v. : No. 5:23-cv-2166 : IDEAL CONCEPTS, INC., : Defendant. : _____________________________________

O P I N I O N

Defendant’s Motion to Dismiss, ECF No. 9 – Granted in part, Denied in part

Joseph F. Leeson, Jr. November 27, 2023 United States District Judge

I. INTRODUCTION Michael Smith was employed by Ideal Concepts, Inc. from December of 2021 until January 27, 2023. During his tenure, he became aware of certain company practices he believed to be unlawful or improper. These included company officers accessing the protected health information of its customers while outside of the United States, fraudulently classifying its employees as Allentown residents to qualify for a tax credit, and laying off employees in violation of the WARN Act. As he became aware of these practices, Smith reported their impropriety to various corporate officials. His complaints were ignored, and he was eventually terminated. Now, he brings claims arising under the False Claims Act, the Pennsylvania Whistleblower Law, and common law wrongful discharge. Ideal Concepts has filed a Motion to Dismiss each of the claims. For the reasons set forth below, the Motion to Dismiss is granted in part and denied in part. II. BACKGROUND The factual allegations, taken from the Amended Complaint, see Am. Compl., ECF No. 9, are as follows: Michael Smith was employed as the Director of Sales for Ideal Concepts, Inc. from December of 2021 until January 27, 2023. Id. ¶¶ 11, 12. Part of Ideal Concepts’ business model

includes selling Medicare and/or Medicaid plans for which it receives funding from the Commonwealth of Pennsylvania. Id. ¶¶ 9, 16. In March of 2022, Smith became aware of certain business practices which he believed to be unlawful and improper. Id. ¶ 13. The first was that Ideal Concepts’ Chief Executive Officer, John Pequeno, moved to Cape Verde, Africa where he continued to perform Medicare related work and accessed protected health information (“PHI”). Id. ¶ 14. Smith avers that accessing PHI outside of the United States violates the Centers for Medicare & Medicaid Services’ (“CMS”) regulations. Id. Around this time, Smith also became aware of Ideal Concepts’ Business Intelligence Reporter, last name Jolla, doing the same while living in Poland. Id. ¶ 15. In addition to violating the CMS, this practice increased the risk that

Ideal Concepts’ customer PHI would be intercepted. Id. ¶ 16. In late March of 2022, Smith reported this information to Susan Galloup, Ideal Concepts’ Director of Human Resources. Id. ¶ 19. In response, Galloup told Smith that she “turns her head and looks the other way” because its “[Pequeno’s] company and he can do what he wants.” Id. Smith then made the same complaints about Jolla and Pequeno’s actions to Ideal Concepts’ Compliance Manager, Health Sales Director of Under Sixty-Five, Sales Strategy Leader, Administrative Service Director, and Pequeno himself. Id. ¶ 20. Nothing was changed in response. Id. ¶ 22. In the months that followed, Pequeno relocated overseas again. In June of 2022, Pequeno relocated to Portugal where he continued to access PHI. Id. ¶ 23. Smith reported this. Id. ¶ 24. In September of 2022, Pequeno relocated to Brazil where he continued to access PHI. Id. ¶ 27. Smith again reported this. Id. ¶ 28. In January of 2023, Smith became aware of two other company practices he deemed

fraudulent and improper. The first was that Ideal Concepts “fraudulently classified its employees across the country as Allentown residents in order to qualify for a tax credit to build an office building in Allentown.” Id. ¶ 29. Smith reported this to Ideal Concepts’ Office of Human Resources. Id. The second was that Pequeno intended to lay off more than fifty (50) employees without notice. Id. ¶ 31. Smith understood this to be a violation of the WARN Act, see 29 U.S.C. § 2101 et seq., and reported such to Galloup. Id. ¶ 32. In January of 2023, Smith complained about the improper PHI access and the fraudulent tax classification once a week to Galloup. Id. ¶ 30. On January 27, 2023, Smith’s employment was terminated. Id. ¶ 35. On August 22, 2023, Smith filed the instant Amended Complaint. In Count I, Smith

asserts a claim of Retaliation in Violation of 31 U.S.C. § 3730(h) of the False Claims Act. In Count II, Smith asserts unlawful retaliation in violation of Pennsylvania Whistleblower Law 43 P.S. § 1421 et seq. In Count III, Smith asserts Common Law Wrongful Discharge in Violation of Pennsylvania Public Policy. On September 5, Ideal Concepts filed a Motion to Dismiss for Failure to State a Claim. See ECF No. 11. The Motion is fully briefed and ready for disposition. For the reasons that follow, Count I is dismissed without prejudice and Ideal Concepts’ motion to dismiss Counts II and III is denied. III. LEGAL STANDARDS A. Motion to Dismiss – Review of Applicable Law Under Rule 12(b)(6), the court must “accept all factual allegations as true [and] construe the complaint in the light most favorable to the plaintiff.” Phillips v. Cnty. of Allegheny, 515 F.3d 224, 233 (3d Cir. 2008) (quoting Pinker v. Roche Holdings Ltd., 292 F.3d 361, 374 n.7 (3d

Cir. 2002)) (internal quotation marks omitted). Only if “the ‘[f]actual allegations . . . raise a right to relief above the speculative level’” has the plaintiff stated a plausible claim. Id. at 234 (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 540, 555 (2007)). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). However, “the tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions.” Id. (explaining that determining “whether a complaint states a plausible claim for relief . . . [is] a context-specific task that requires the reviewing court to draw on its judicial experience and common sense”). “In deciding a Rule

12(b)(6) motion, a court must consider only the complaint, exhibits attached to the complaint, matters of public record, as well as undisputedly authentic documents if the complainant’s claims are based upon these documents.” Mayer v. Belichick, 605 F.3d 223, 230 (3d Cir. 2010). Additionally, “a document integral to or explicitly relied upon in the complaint may be considered.” In re Burlington Coat Factory Sec. Litig., 114 F.3d 1410, 1426 (3d Cir. 1997) (internal quotations omitted). The defendant bears the burden of proving that a plaintiff has failed to state a claim upon which relief can be granted. See Hedges v. United States, 404 F.3d 744, 750 (3d Cir. 2005) (citing Kehr Packages, Inc. v. Fidelcor, Inc., 926 F.2d 1406, 1409 (3d Cir. 1991)). B. False Claims Act Retaliation – Review of Applicable Law Generally, the False Claims Act (“FCA”) was enacted “to protect the funds and property of the Government from fraudulent claims.” Rainwater v.

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SMITH v. IDEAL CONCEPTS, INC., Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-ideal-concepts-inc-paed-2023.