State of Texas v. Xerox Corporation Settlement Proceeds
Opinion
ACCEPTED 15-25-00034-CV FIFTEENTH COURT OF APPEALS AUSTIN, TEXAS 10/2/2025 2:56 PM No. 15-25-00034-CV CHRISTOPHER A. PRINE CLERK
In the Court of Appeals 15th COURT FILED IN OF APPEALS
for the Fifteenth Judicial District10/2/2025 2:56:47 PM AUSTIN, TEXAS
CHRISTOPHER A. PRINE Clerk The State of Texas, Appellant, v. Alexandra Alvarez, Joshua LaFountain, Christine Ellis, DDS, Appellees.
On Appeal from the 459th Judicial District Court, Travis County
REPLY BRIEF FOR APPELLANT
Ken Paxton Austin Kinghorn Attorney General of Texas Deputy Attorney General for Civil Brent Webster Litigation First Assistant Attorney General Amy Snow Hilton Chief, Healthcare Program Ralph Molina Enforcement Division Deputy First Assistant Attorney Brian VanderZanden General Texas State Bar No. 24081557 Office of the Attorney General Assistant Attorney General P.O. Box 12548 (MC 059) Healthcare Program Enforcement Austin, Texas 78711-2548 Division Tel.: (512) 936-1700 Fax: (512) 474-2697 Counsel for Appellant
Oral Argument Requested TABLE OF CONTENTS
Table of Contents.................................................................................................... i
Index of Authorities .............................................................................................. iii
Introduction ............................................................................................................ 1
Argument............................................................................................................... 2
I. Appellees Cannot Establish Jurisdiction in this Alternate-Remedy Proceeding ..................................................................................................................... 2
II. The Allegations in Appellees’ Petitions Were Publicly Disclosed ................ 6
A. Appellees Fail To Identify Any Allegations That Were Not Disclosed in at Least One of the Public Disclosures ........................................... 6
B. The Public Disclosures Do Not Need To Accuse Xerox of “Fraud” To Bar Appellees ...................................................................................... 7
C. Statements Made by the State in Malouf and Other Provider Cases Cannot Save Appellees from the Public Disclosure Bar...................... 9
D. The Timing of the State’s Investigation into Xerox’s Fraud Has No Bearing on Whether Appellees Are Barred by Public Disclosure ....... 11
E. There is No Jurisdictional Difference Between the Public Disclosure Bars in the FCA and the TMFPA ..................................................... 12
F. LaFountain and Ellis Are Not Original Sources. ............................... 12
1. LaFountain did not have “direct” knowledge that was voluntarily disclosed ............................................................................... 12
2. Ellis is not an original source. .................................................. 16
a. Arguments in separate provider cases do not give Ellis original source status..................................................... 16
b. Ellis’s disclosures to the State do not establish her as an original source............................................................... 17 i III. LaFountain and Ellis Are Barred by the TMFPA’s First-to-File Bar.......... 20
A. The Third Court of Appeals Did Not Rule on the Merits of the First- to-File Bar ........................................................................................ 20
B. LaFountain’s Mention of Xerox’s Activity-Based Compensation Program Cannot Avoid the First-to-File Bar ..................................... 21
C. The Two Allegations in Ellis’s Petition Identified by Appellees Are Not Distinct Allegations of Fraud ........................................................... 24
IV. The TMFPA Does Not Authorize Awarding Interest Against the State .... 26
V. Because LaFountain and Ellis Are Not “Original Sources” They Are Not Entitled to a 0-7% Fee Determination ......................................................... 29
Prayer ................................................................................................................... 33
Certificate of Compliance ..................................................................................... 34
ii INDEX OF AUTHORITIES
Cases Page
Abbott v. BP Expl. & Prod., Inc., 851 F.3d 384 (5th Cir. 2017) ................................. 12
Alfonso v. Skadden, 251 S.W.3d 52 (Tex. 2008) ....................................................... 5
Bituminous Casualty Corp. v. Vacuum Tanks, Inc., 75 F.3d 1048 (5th Cir. 1996) .... 28
Brown v. De La Cruz, 156 S.W.3d 560 (Tex. 2004)................................................. 4
Cavnar v. Quality Control Parking, Inc., 696 S.W.2d 549 (Tex. 1985) ........ 27, 28, 29
Cho ex rel. States v. Surgery Partners, Inc., 30 F.4th 1035 (11th Cir. 2022) ..............26
City of Hutchins v. Prasifka, 450 S.W.2d 829 (Tex. 1970) .................................10, 17
Fed. Recovery Servs., Inc. v. United States, 72 F.3d 447 (5th Cir. 1995)....................30
Glaser v. Wound Care Consultants, 570 F.3d 907 (7th Cir. 2009) ........................... 13
Hays v. Hoffman, 325 F.3d 982 (8th Cir. 2003)...................................................... 31
In re S.A.P., 156 S.W.3d 574 (Tex. 2005) ..................................................... 5, 10, 17
In re Xerox Corp., 555 S.W.3d 518 (Tex. 2018) (orig. proceeding).................... 27, 28
Jones v. Ignal, 798 S.W.2d 898 (Tex. App.—Austin 1990, writ denied)................... 5
Little v. Shell Expl. & Prod. Co., 690 F.3d 282 (5th Cir. 2012) ................................ 19
Malouf v. State ex rel. Ellis, 694 S.W.3d 712 (Tex. 2024)......................................... 9
Matter of Ament, 890 S.W.2d 39 (Tex. 1994) ......................................................... 26
Morgan v. Ebby Halliday Real Estate, Inc., 873 S.W.2d 385 (Tex. App.—Fort Worth 1993, no writ) ............................................................................................... 27, 28
Nazari v. State, 561 S.W.3d 495 (Tex. 2018) ........................................................ 28
Origin Bank v. Castellano, No. 4:21-CV-02173, 2024 WL 169664 (S.D. Tex. Jan. 12, 2024) ................................................................................................................. 27
iii Prather v. AT&T, Inc., 847 F.3d 1097 (9th Cir. 2017)............................................. 16
Rille v. PriceWaterhouseCoopers LLP, 803 F.3d 368 (8th Cir. 2015) ........................ 32
Rockwell Intern. Corp. v.
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ACCEPTED 15-25-00034-CV FIFTEENTH COURT OF APPEALS AUSTIN, TEXAS 10/2/2025 2:56 PM No. 15-25-00034-CV CHRISTOPHER A. PRINE CLERK
In the Court of Appeals 15th COURT FILED IN OF APPEALS
for the Fifteenth Judicial District10/2/2025 2:56:47 PM AUSTIN, TEXAS
CHRISTOPHER A. PRINE Clerk The State of Texas, Appellant, v. Alexandra Alvarez, Joshua LaFountain, Christine Ellis, DDS, Appellees.
On Appeal from the 459th Judicial District Court, Travis County
REPLY BRIEF FOR APPELLANT
Ken Paxton Austin Kinghorn Attorney General of Texas Deputy Attorney General for Civil Brent Webster Litigation First Assistant Attorney General Amy Snow Hilton Chief, Healthcare Program Ralph Molina Enforcement Division Deputy First Assistant Attorney Brian VanderZanden General Texas State Bar No. 24081557 Office of the Attorney General Assistant Attorney General P.O. Box 12548 (MC 059) Healthcare Program Enforcement Austin, Texas 78711-2548 Division Tel.: (512) 936-1700 Fax: (512) 474-2697 Counsel for Appellant
Oral Argument Requested TABLE OF CONTENTS
Table of Contents.................................................................................................... i
Index of Authorities .............................................................................................. iii
Introduction ............................................................................................................ 1
Argument............................................................................................................... 2
I. Appellees Cannot Establish Jurisdiction in this Alternate-Remedy Proceeding ..................................................................................................................... 2
II. The Allegations in Appellees’ Petitions Were Publicly Disclosed ................ 6
A. Appellees Fail To Identify Any Allegations That Were Not Disclosed in at Least One of the Public Disclosures ........................................... 6
B. The Public Disclosures Do Not Need To Accuse Xerox of “Fraud” To Bar Appellees ...................................................................................... 7
C. Statements Made by the State in Malouf and Other Provider Cases Cannot Save Appellees from the Public Disclosure Bar...................... 9
D. The Timing of the State’s Investigation into Xerox’s Fraud Has No Bearing on Whether Appellees Are Barred by Public Disclosure ....... 11
E. There is No Jurisdictional Difference Between the Public Disclosure Bars in the FCA and the TMFPA ..................................................... 12
F. LaFountain and Ellis Are Not Original Sources. ............................... 12
1. LaFountain did not have “direct” knowledge that was voluntarily disclosed ............................................................................... 12
2. Ellis is not an original source. .................................................. 16
a. Arguments in separate provider cases do not give Ellis original source status..................................................... 16
b. Ellis’s disclosures to the State do not establish her as an original source............................................................... 17 i III. LaFountain and Ellis Are Barred by the TMFPA’s First-to-File Bar.......... 20
A. The Third Court of Appeals Did Not Rule on the Merits of the First- to-File Bar ........................................................................................ 20
B. LaFountain’s Mention of Xerox’s Activity-Based Compensation Program Cannot Avoid the First-to-File Bar ..................................... 21
C. The Two Allegations in Ellis’s Petition Identified by Appellees Are Not Distinct Allegations of Fraud ........................................................... 24
IV. The TMFPA Does Not Authorize Awarding Interest Against the State .... 26
V. Because LaFountain and Ellis Are Not “Original Sources” They Are Not Entitled to a 0-7% Fee Determination ......................................................... 29
Prayer ................................................................................................................... 33
Certificate of Compliance ..................................................................................... 34
ii INDEX OF AUTHORITIES
Cases Page
Abbott v. BP Expl. & Prod., Inc., 851 F.3d 384 (5th Cir. 2017) ................................. 12
Alfonso v. Skadden, 251 S.W.3d 52 (Tex. 2008) ....................................................... 5
Bituminous Casualty Corp. v. Vacuum Tanks, Inc., 75 F.3d 1048 (5th Cir. 1996) .... 28
Brown v. De La Cruz, 156 S.W.3d 560 (Tex. 2004)................................................. 4
Cavnar v. Quality Control Parking, Inc., 696 S.W.2d 549 (Tex. 1985) ........ 27, 28, 29
Cho ex rel. States v. Surgery Partners, Inc., 30 F.4th 1035 (11th Cir. 2022) ..............26
City of Hutchins v. Prasifka, 450 S.W.2d 829 (Tex. 1970) .................................10, 17
Fed. Recovery Servs., Inc. v. United States, 72 F.3d 447 (5th Cir. 1995)....................30
Glaser v. Wound Care Consultants, 570 F.3d 907 (7th Cir. 2009) ........................... 13
Hays v. Hoffman, 325 F.3d 982 (8th Cir. 2003)...................................................... 31
In re S.A.P., 156 S.W.3d 574 (Tex. 2005) ..................................................... 5, 10, 17
In re Xerox Corp., 555 S.W.3d 518 (Tex. 2018) (orig. proceeding).................... 27, 28
Jones v. Ignal, 798 S.W.2d 898 (Tex. App.—Austin 1990, writ denied)................... 5
Little v. Shell Expl. & Prod. Co., 690 F.3d 282 (5th Cir. 2012) ................................ 19
Malouf v. State ex rel. Ellis, 694 S.W.3d 712 (Tex. 2024)......................................... 9
Matter of Ament, 890 S.W.2d 39 (Tex. 1994) ......................................................... 26
Morgan v. Ebby Halliday Real Estate, Inc., 873 S.W.2d 385 (Tex. App.—Fort Worth 1993, no writ) ............................................................................................... 27, 28
Nazari v. State, 561 S.W.3d 495 (Tex. 2018) ........................................................ 28
Origin Bank v. Castellano, No. 4:21-CV-02173, 2024 WL 169664 (S.D. Tex. Jan. 12, 2024) ................................................................................................................. 27
iii Prather v. AT&T, Inc., 847 F.3d 1097 (9th Cir. 2017)............................................. 16
Rille v. PriceWaterhouseCoopers LLP, 803 F.3d 368 (8th Cir. 2015) ........................ 32
Rockwell Intern. Corp. v. U.S., 549 U.S. 457 (2007) .......................................... 10, 16
Rupert v. McCurdy, 141 S.W.3d 334 (Tex. App.—Dallas 2004, no pet.) .................. 5
State Department of Highways and Public Transportation v. Bacon, 754 S.W.2d 279 (Tex. App.—Texarkana 1988, writ denied) ................................................. 28, 29
State v. Durham, 860 S.W.2d 63 (Tex. 1993) ....................................................10, 17
State v. Ellis, 681 S.W.3d 501 (Tex. App.—Austin 2023, no pet.) ........... 4, 5, 20, 21
Tex. Dept. of Parks & Wildlife v. Miranda, 133 S.W.3d 217 (Tex. 2004).................... 5
Tex. Med. Res., LLP v. Molina Healthcare of Tex., Inc., 659 S.W.3d 424 (Tex. 2023) ........................................................................................................................ 3, 4
United States ex rel. Barth v. Ridgedale Elec., Inc., 44 F.3d 699 (8th Cir. 1995) ........ 16
United States ex rel. Branch Consultants v. Allstate Ins. Co., 560 F.3d 371 (5th Cir. 2009) ................................................................................................................. 25
United States ex rel. Burke v. St. Jude Med., Inc., No. CV 16-3611-SAG, 2021 WL 6135202 (D. Md. Dec. 29, 2021) ........................................................................ 30
United States ex rel. Findley v. FPCBoron Emps.’ Club, 105 F.3d 675 (D.C. Cir. 1997) .......................................................................................................................... 31
United States ex rel. Hampton v. Columbia/HCA Healthcare Corp., 318 F.3d 214 (D.C. Cir. 2003)................................................................................................ 22
United States ex rel. Harman v. Trinity Indus., Inc., No. 2:12–CV–00089–JRG, 2014 WL 47258 (E.D. Tex. Jan. 6, 2014) .................................................................... 14
United States ex rel. Heath v. AT & T, Inc., 791 F.3d 112 (D.C. Cir. 2015) ........ 22, 23
United States ex rel. Holloway v. Heartland Hospice, Inc., 960 F.3d 836 (6th Cir. 2020) ................................................................................................................. 11
iv United States ex rel. Karadsheh v. Fata, No. 2:13-cv-13333, 2019 WL 6702141 (E.D. Mich. Dec. 9, 2019) ........................................................................................... 32
United States ex rel. LaCorte v. Wagner, 185 F.3d 188 (4th Cir. 1999) ...................... 2
United States ex rel. Lam v. Tenet Healthcare Corp., 287 F. App’x 396 (5th Cir. 2008) ................................................................................................................. 15
United States ex rel. Merena v. SmithKline Beecham Corp., 114 F. Supp. 2d 352 (E.D. Pa. 2000) ........................................................................................................... 30
United States ex rel. Merena v. SmithKline Beecham Corp., 205 F.3d 97 (3d Cir. 2000) .......................................................................................................................... 30
United States ex rel. Montgomery v. St. Edward Mercy Med. Ctr., No. 4:05-cv-00899, 2007 WL 2904111 (E.D. Ark. Sept. 28, 2007) .................................................... 31
United States ex rel. Rahimi v. Rite Aid Corp., 3 F.4th 813 (6th Cir. 2021)......... 7, 8, 9
United States ex rel. Reagan v. East Texas Medical Center Regional Healthcare System, 384 F.3d 168 (5th Cir. 2004) .............................................................................. 13
United States ex rel. Saldivar v. Fresenius Med. Care Holdings, Inc., 841 F.3d 927 (11th Cir. 2016) .................................................................................................. 14
United States ex rel. Wood v. Allergan, Inc., 899 F.3d 163 (2d Cir. 2018) ................ 22
United States v. A.D. Roe Co., 186 F.3d 717 (6th Cir. 1999) ..................................... 8
United States v. L-3 Commc’ns EOTech, Inc., 921 F.3d 11 (2d Cir. 2019) ................. 2
United States v. Wegeler, 941 F.3d 665 (3d Cir. 2019) .............................................. 2
Statutes
31 U.S.C. § 3730(d)(1) .......................................................................................... 30
31 U.S.C. § 3730(e)(4) .......................................................................................... 30
Tex. Gov’t Code 402.004 ................................................................................10, 17
v Tex. Hum. Res. Code §§ 36.002(1), (2) ................................................................ 25
Tex. Hum. Res. Code § 36.051................................................................................ 3
Tex. Hum. Res. Code § 36.106 ............................................................................. 26
Tex. Hum. Res. Code § 36.109(a) .......................................................................... 2
Tex. Hum. Res. Code § 36.110(b) .............................................................. 29, 30, 31
Tex. Hum. Res. Code § 36.110(c) ......................................................................... 29
Tex. Hum. Res. Code § 36.113(b) .................................................................. passim
Tex. Hum. Res. Code § 36.113(b)(1) ................................................................ 13, 15
Tex. Ins. Code § 1271.155(a) .................................................................................. 4
Tex. Rev. Civ. Stat. art. 5069–1.05 § 6(a) ............................................................. 28
Rules
Tex. R. App. P. 9.4(e) ........................................................................................... 34
Tex. R. App. P. 9.4(i) ............................................................................................ 34
Tex. R. App. P. 9.4(i)(1)........................................................................................ 34
Tex. R. Civ. P. 45 .................................................................................................... 5
vi INTRODUCTION
This case should be dismissed for a lack of subject-matter jurisdiction because
Appellees have failed to plead a cause of action that is not barred by sovereign
immunity. Appellees have no right to a relator’s share determination in this
alternate-remedy proceeding as opposed to their original proceedings, where they
should have brought their motion.
If allowed to go forward, this case turns on whether Appellees’ allegations
were publicly disclosed. If they were not, Appellees will be awarded $37,160,865.00,
and the only remaining issue is whether they are entitled to an additional
$11,044,503.70 in prejudgment interest. If their allegations were publicly disclosed,
because Alvarez does not claim to be an “original source,” Appellees are only
eligible for a 0-7% award determination if LaFountain and Ellis prove they are both
“original sources” and they survive the first-to-file bar. (And even then, because
Appellees did not provide significant information or play a role in advancing State v.
Xerox to litigation, they are entitled to 0%.)
Appellees fail to identify a single allegation in their petitions that was not
publicly disclosed in at least one of the disclosures identified in the State’s opening
brief. Instead, Appellees rely upon statements made by the State in different cases
and argue about the date the State’s investigation began. But neither is relevant to
1 the issue of public disclosure. Neither LaFountain nor Ellis qualify as “original
sources,” and both are barred by the first-to-file bar. Accordingly, Appellees are
entitled to nothing.
ARGUMENT
I. Appellees Cannot Establish Jurisdiction in this Alternate-Remedy Proceeding.
Although Appellees contend they “must be able to vindicate their statutory
right to a share of a settlement that resolves their claims” (at 25), the alternate-
remedy provision of the TMFPA does not confer a relator with the unfettered right
to a determination of the relator’s share within the alternate proceeding. See Tex.
Hum. Res. Code § 36.109(a). Appellees fail to explain why they cannot “vindicate”
their purported rights to a relator’s share in their original actions, which is routinely
required in federal False Claims Act cases. See United States ex rel. LaCorte v.
Wagner, 185 F.3d 188, 191 (4th Cir. 1999); United States v. Wegeler, 941 F.3d 665,
672 (3d Cir. 2019); United States v. L-3 Commc’ns EOTech, Inc., 921 F.3d 11, 30 (2d
Cir. 2019). While Appellees point out these cases have factual distinctions (at 24-
25), each supports the State’s position that the appropriate proceeding in which to
seek a relator’s share is the relator’s original proceeding, not the alternative-remedy
2 proceeding. 1 Appellees’ argument that precluding them from seeking a relator’s
share determination in the State’s alternate-remedy proceeding would “leave[] to
the State’s discretion alone whether and in what amount to pay an award” fails to
contemplate relators’ right to a share in their original proceedings and must
therefore be rejected.
Appellees argue that “the TMFPA expressly entitles them to a share of the
proceeds.” Appellees’ Br. 19-20. The TMFPA, however, expressly provides only
four causes of action. See Tex. Hum. Res. Code § 36.051 (allowing attorney general
to seek injunctive relief relating to violation of section 36.002); 36.052 (allowing
attorney general to seek civil remedies and penalties for violation of 36.002); 36.101
(authorizing private person to bring a cause of action for violation of 36.002); and
36.115(b) (creating cause of action for retaliation against qui tam relator). The fact
that the Legislature failed to provide a cause of action allowing private enforcement
of Section 36.110 is dispositive of the issue.
The Texas Supreme Court has “ma[de] clear that the bar for implying a
private cause of action is high.” Tex. Med. Res., LLP v. Molina Healthcare of Tex., Inc.,
659 S.W.3d 424, 431 (Tex. 2023). “When a private cause of action is alleged to derive
1 Although Alvarez nonsuited her original case (Appellees’ Br. 11) LaFountain and Ellis did not. Appellees represent that they have “a sharing agreement” (Appellees’ Br. 53) which gives Alvarez a portion of any recovery. 3 from a constitutional or statutory provision, our duty is to ascertain the drafters’
intent.” Id. “[T]he existence of the private cause of action must be clearly implied
in the statutory text.” Id. In Molina, the Texas Supreme Court was asked whether a
cause of action may be implied by a statutory provision that unambiguously entitled
“physicians or providers” to reimbursement from insurance companies for
“emergency care performed by non-network physicians or providers.” Id. at 427
(quoting Tex. Ins. Code § 1271.155(a)). The Court explained that even though the
statute at issue provided a “textual entitlement to compensation,” it did not “clearly
impl[y]” a cause of action. Id. at 431-32. “The very balance of state governmental
power imposed by the framers of the Texas Constitution depends on each branch,
and particularly the judiciary, operating within its jurisdictional bounds. By implying
a private cause of action in a statute that did not provide for one, the [lower court]
exceeded those bounds.” Id. at 432 (quoting Brown v. De La Cruz, 156 S.W.3d 560,
569 (Tex. 2004)).
Appellees argue the issue of the State’s sovereign immunity was resolved in
State v. Ellis, 681 S.W.3d 501 (Tex. App.—Austin 2023, no pet.). There, the State
argued that sovereign immunity deprived the trial court of jurisdiction to hear
LaFountain and Ellis’s motion because they were not the first to file. Id. at 504. The
Third Court held that sovereign immunity does not apply to Appellees’ joint motion
4 because the joint motion is not a “suit at all.” 681 S.W.3d at 512 n.8. The Third
Court’s opinion did not address whether Appellees’ joint motion may properly form
the sole basis of this severed cause because that issue was not before the court.
While Appellees contend that the invited error doctrine precludes the State
from challenging subject matter jurisdiction (at 22), a party cannot waive subject-
matter jurisdiction, and sovereign immunity deprives a trial court of jurisdiction.
Alfonso v. Skadden, 251 S.W.3d 52, 55 (Tex. 2008) (“Subject-matter jurisdiction
cannot be waived, and can be raised at any time.”); Tex. Dept. of Parks & Wildlife v.
Miranda, 133 S.W.3d 217, 224–25 (Tex. 2004).
Appellees next argue that their joint motion seeking a relator share of the
Xerox proceeds “creates a cause of action.” Appellees’ Br. 22. A motion, however,
is not a pleading and cannot by itself create a cause of action. In re S.A.P., 156 S.W.3d
574, 576 n.3 (Tex. 2005). “The only pleadings in a cause are by petition and answer.”
Jones v. Ignal, 798 S.W.2d 898, 900 n.1 (Tex. App.—Austin 1990, writ denied)
(citing Tex. R. Civ. P. 45). A “motion” is “an application for an order,” which is
entirely different from a “pleading” that is “a statement … of the plaintiff’s cause
of action.” Rupert v. McCurdy, 141 S.W.3d 334, 339 (Tex. App.—Dallas 2004, no
pet.)
5 II. The Allegations in Appellees’ Petitions Were Publicly Disclosed.
A. Appellees Fail To Identify Any Allegations That Were Not Disclosed in at Least One of the Public Disclosures.
Appellees do not identify any allegations that were not publicly disclosed in at
least one of the public disclosures—nor can they. Allegations that Medicaid funds
were approved by Xerox even though the braces were for cosmetic or aesthetic
reasons was publicly disclosed. See Ex. G-4; C.R.5197, at 2:00-2:10; C.R.4553.
Allegations that Xerox did not comply with Medicaid criteria and guidelines was also
publicly disclosed. See C.R.4543–44; 4482–83; 4546–49; 4507–08. Likewise, the fact
that Xerox was approving improper claims was publicly disclosed. See Ex. G-4;
C.R.5197 at 2:00-2:10; Ex. G-8; C.R.5197 at 4:10–4:17. As was the allegation that
Xerox was approving claims without properly reviewing them first, i.e., “rubber
stamping” them. See C.R.4543–44; C.R.4553; Ex. G-8; C.R.5197 at 4:10–4:17.
Appellees argue that several of the public disclosures describe orthodontic
claims being improperly approved by the “State,” not Xerox. Appellees’ Br. 28-44.
Every public disclosure that references the “State” approving orthodontic claims is
plainly referring to the contractor tasked with reviewing claims, i.e., Xerox, as no
other State contractor processed orthodontic claims for Texas Medicaid at that time.
See C.R.6440 ¶ 1.04. For example, Appellees argue that the May 13, 2011, WFAA
article does not explicitly mention “Xerox” by name. Appellees’ Br. 33 n.6. That
6 article, however, refers to “claims [being] processed by an outside contractor in
Texas,” which could refer to only Xerox. C.R.4543.
Appellees go to great lengths arguing that each individual public disclosure
fails to disclose some allegation of fraud. Appellees’ Br. 28-44.2 For example,
Appellees point out that some of the earlier public disclosures did not mention
ACS/Xerox by name (see, e.g., Id. at 30, 33-34, 40) only to concede that the
November 11, 2011, WFAA broadcast “first named” ACS/Xerox. Id. at 50. There
is no requirement, however, that all allegations of fraud be contained in a single
disclosure. United States ex rel. Rahimi v. Rite Aid Corp., 3 F.4th 813, 824 (6th Cir.
2021) (stating that “a public disclosure can also be piecemeal so long as the multiple
sources of information reveal the allegation of fraud and its essential elements”).
Because Appellees fail to identify any essential elements of fraud that were not
publicly disclosed in at least one of the public disclosures, they must be barred.
B. The Public Disclosures Do Not Need To Accuse Xerox of “Fraud” To Bar Appellees.
Appellees argue that the public disclosures do not specifically accuse Xerox of
committing “fraud.” Appellees’ Br. 33, 34, 43. Not true. The August 30, 2011,
2 While Appellees take issue with each individual public disclosure, the November 11, 2011, WFAA broadcast (Ex. G-8; C.R.5197) so clearly discloses all the fraudulent allegations that Appellees have no choice but to fall back on the argument that “LaFountain and Ellis are original sources.” Appellees’ Br. 42. 7 HHSC news release explicitly states that “[a]ny cases of suspected fraud will be
referred to the Office of the Attorney General.” C.R.4507–08 (emphasis added).
The December 16, 2011, WFAA broadcast does so, too. Ex. G-9, C.R.5197, at 1:41–
1:50 (“I gotta tell you if there was fraud taking place somebody needs to be
accountable for that, and I’m not talking about just paying the money back.”
(emphasis added)). Regardless, the public disclosures do not need to use the word
“fraud” to bar Appellees. Rahimi, 3 F.4th at 823 (citing United States v. A.D. Roe
Co., 186 F.3d 717, 724 (6th Cir. 1999) (“[P]ublicly disclosed documents need not use
the word ‘fraud,’ but need merely to disclose information which creates ‘an
inference of impropriety.’”)).
As even Appellees acknowledge, the public disclosures:
• state[d] that Xerox “took advantage” (at 32);
• disclosed “severe overutilization” (at 33);
• described “questionable Medicaid spending” (at 37);
• call[ed] “ACS ‘a virtual assembly line of claims processing’” (at 41);
8 • warned viewers that “your tax dollars aren’t working. You’re paying
for services that shouldn’t be paid for” (id.); and
• stated that the “Medicaid orthodontic benefit is ‘abused’”3 (at 42).
By Appellees’ own admission, there can be no question that the public disclosures
create “an inference of impropriety” on ACS/Xerox’s behalf, which is all that is
required to bar Appellees. Rahimi, 3 F.4th at 823.
C. Statements Made by the State in Malouf and Other Provider Cases Cannot Save Appellees from the Public Disclosure Bar.
Appellees make much of the fact that the State argued that Ellis was a “bona
fide relator” and that “there were no public disclosures” that would have barred
Ellis in severed qui tam cases she brought against dental providers. Appellees’ Br. 11,
26. As the State explained in its opening brief, Ellis named several providers in her
qui tam petition, including Dr. Richard Malouf, Harlingen Family Dentistry, and
ASDC Holdings, LLC. See Appellant’s Br. 41-42 (citing C.R.7668-71); C.R.173;
CR.3129. The allegations in the provider cases, however, were entirely different
from the allegations against Xerox. For example, in Malouf, Dr. Malouf was alleged
to have used his provider number for services performed by other dentists. Malouf v.
State ex rel. Ellis, 694 S.W.3d 712, 717 (Tex. 2024). That fact was never publicly
3 This news report quotes Ellis. Ex. G-9, C.R.5171 at 0:31-0:33. There is no exception for a relator’s own public disclosure, however, so Ellis’s own public statements bar her just the same as the other public disclosures. See Tex. Hum. Res. Code § 36.113(b) (2011). 9 disclosed prior to the lawsuit. That Ellis may have been a bona fide relator in the
provider cases does not mean that she – or the other appellees – is a bona fide relator
here. See Rockwell Intern. Corp. v. U.S., 549 U.S. 457, 476 (2007).
But even if the State had previously taken the position that Ellis was a “bona
fide relator” in the Xerox case (which it did not do), the State is not estopped from
now challenging her status. Tex. Gov’t Code 402.004 (“An admission, agreement,
or waiver made by the attorney general in an action or suit to which the state is a
party does not prejudice the rights of the state.”); see also S.A.P., 156 S.W.3d at 577
(stating that “equitable estoppel generally does not apply to governmental
entities”); State v. Durham, 860 S.W.2d 63, 67 (Tex. 1993) (“[T]he State in its
sovereign capacity, unlike ordinary litigants, is not subject to the defenses of
limitations, laches, or estoppel.”); City of Hutchins v. Prasifka, 450 S.W.2d 829, 835
(Tex. 1970) (“The general rule has been in this state that when a unit of government
is exercising its governmental powers, it is not subject to estoppel.”). The State’s
statements about Ellis’s relator status in the provider cases do not estop the State
from challenging her relator status here.
10 D. The Timing of the State’s Investigation into Xerox’s Fraud Has No Bearing on Whether Appellees Are Barred by Public Disclosure.
Appellees argue that “Texas only began investigation Xerox’s TMFPA
violations in June 2012.” Appellees’ Br. 26. Not so. The State’s investigation began
in January 2011. See C.R. 1161-62 (State Action Request notifying Xerox of
“performance issues with the prior authorizations of orthodontic requests”). The
2012 date cited by Relators is when the Texas “Attorney General’s Office, together
with the Texas Health & Human Services Commission (HHSC) and the HHSC-
Office of Inspector General formed a dental and orthodontic fraud task force,” not
the date when the State’s investigation began. CR.211 (emphasis added). The date
the task force was formed was included (incorrectly) in the Xerox settlement
agreement as the date when “the State of Texas initiated an investigation” against
Xerox (C.R.27), rather than the actual date the State launched its investigation by
sending Xerox the State Action Request on January 19, 2011.
Regardless, the date the State initiated its investigation into Xerox’s conduct
has no bearing on whether Appellees are barred by public disclosure. The public
disclosure bar applies “once a general disclosure of fraud has been made,” in which
case, courts “presume that the government is on notice.” United States ex rel.
Holloway v. Heartland Hospice, Inc., 960 F.3d 836, 848 (6th Cir. 2020). There is no
requirement that the State have actual knowledge of fraud or even be aware of the
11 public disclosures for the bar to apply. See Tex. Hum. Res. Code § 36.113(b). Thus,
even if Appellees are correct, and the State’s investigation began in June 2012,
Appellees would still be barred because all the allegations in their petitions were
publicly disclosed.
E. There is No Jurisdictional Difference Between the Public Disclosure Bars in the FCA and the TMFPA.
Appellees argue that the TMFPA’s public-disclosure bar differs from the
FCA public-disclosure bar “to favor allowing even [TMFPA] cases with significant
public disclosures to go forward.” Appellees’ Br. 28. Appellees base this assertion
on the false premise that the FCA public disclosure bar is “jurisdictional” while the
TMFPA’s public disclosure bar is not. Id. The FCA was amended in 2010. Abbott v.
BP Expl. & Prod., Inc., 851 F.3d 384, 387 n.2 (5th Cir. 2017) (“We agree with our
sister circuits that the public disclosure bar is no longer jurisdictional.”). Because
neither public disclosure bar is jurisdictional, Appellees’ argument that the
TMFPA’s public disclosure bar is easier to circumvent must be rejected.
F. LaFountain and Ellis Are Not Original Sources.
1. LaFountain did not have “direct” knowledge that was voluntarily disclosed.
Appellees argue that LaFountain is an original source based solely on his
uncorroborated, self-serving testimony that he “addressed his concerns about
Xerox” at a meeting with OIG that allegedly took place on some unspecified date 12 “in 2011.” Appellees’ Br. 7, 47. Regardless, LaFountain cannot be an original source
because he did not have “direct” knowledge of the fraud alleged in his petition with
respect to Xerox. See Tex. Hum. Res. Code § 36.113(b)(1).
Appellees contend that LaFountain “learned the information on which he
based his allegations on the job while his employer [Bear Creek] exploited the very
fraud on Medicaid that he alleged Xerox committed.” Appellees’ Br. 48. This is
secondhand knowledge and not “direct.” Appellees cite Glaser v. Wound Care
Consultants, 570 F.3d 907 (7th Cir. 2009), for the proposition that personal
involvement in Medicaid by itself is sufficient to confer original source status.
Appellees’ Br. at 48. The relator in Glaser, however, was found not to be an original
source, because even though she had personally been treated by a physician’s
assistant and not a doctor, she did not directly witness the fraudulent claims being
billed. Glaser, 570 F.3d at 921. Likewise, LaFountain saw Bear Creek’s claims being
approved, but he did not directly witness Xerox’s rubber-stamping or its failure to
hire qualified staff. Appellees cite (at 48) to United States ex rel. Reagan v. East Texas
Medical Center Regional Healthcare System, but again, that relator was found not to be
an original source. 384 F.3d 168, 179 (5th Cir. 2004) (stating that “second-hand
information” may not be “converted into ‘direct and independent knowledge’
13 simply because the plaintiff discovered through investigation or experience what the
public already knew”).
In a third case relied upon by Appellees, United States ex rel. Harman v. Trinity
Indus., Inc., the relator was found to be an original source in a case involving defective
highway guardrails. No. 2:12–CV–00089–JRG, 2014 WL 47258, at *6 (E.D. Tex.
Jan. 6, 2014). The relator learned, “through [his] own inspection,” that the
guardrails were defective, having “inspected approximately 100 crash sites in several
states and took measurements of approximately 125 [guardrails] on highways
throughout the nation.” Id. at *4. In contrast, LaFountain admitted that his
knowledge of Xerox’s internal operations came not from his personal observations,
but second-hand from conversations he had with his employer or with Dr. Bob
Anderton.4 CR.4850 at 35:16-CR.4851 at 36:1. This amounts to “indirect”
knowledge since it was obtained from others. See United States ex rel. Saldivar v.
Fresenius Med. Care Holdings, Inc., 841 F.3d 927, 936 (11th Cir. 2016) (ruling that
hearing about improper billing practices from coworkers in another department is
“on its face indirect”). Any knowledge LaFountain obtained from his employer or
Dr. Anderton is not direct because it was “based on knowledge received from other
4 Dr. Anderton was a dentist who provided training at Bear Creek. CR.4851 at 36:25-CR.4852 at 37:4. 14 persons.” United States ex rel. Lam v. Tenet Healthcare Corp., 287 F. App’x 396, 400-
01 (5th Cir. 2008).
LaFountain testified that his allegations concerning Xerox’s conduct was
predicated on him seeing Bear Creek’s claims being approved. CR.4848 at 33:17-19
(“That’s based on me seeing what was submitted to them and what they
approved.”). LaFountain testified that he never had any dealings with Xerox or knew
anyone who worked there. CR.4844-46, at 29:1-31:16. To the extent LaFountain had
firsthand knowledge of anything, it was of fraudulent documentation submitted by
his employer, Bear Creek, to Texas Medicaid—not of Xerox’s actions. CR.4848 at
33:17-19. In other words, what LaFountain personally witnessed was Bear Creek
submitting fraudulent orthodontic claims (which he alleged in his petition), not
Xerox rubber-stamping claims, employing unqualified personnel, or failing to get
dental director approval when required—i.e., the allegations in the State’s petition
against Xerox. Id.
Moreover, LaFountain did not “voluntarily” disclose his findings to the State.
See Tex. Hum. Res. Code § 36.113(b)(1). When he spoke to OIG in 2011 it was “after
it initiated an investigation into his employer” Bear Creek. Appellees’ Br. 47
(emphasis added). The fact that Xerox was approving orthodontic claims that did
not qualify for reimbursement was publicly disclosed throughout 2011. See
15 C.R.4543–44, 4482–83, 4546–49, 4507–08. Appellees argue that OIG was
investigating different fraud, but because LaFountain’s disclosure was done in
response to a government audit, they were not “voluntary.” See United States ex rel.
Barth v. Ridgedale Elec., Inc., 44 F.3d 699, 704 (8th Cir. 1995) (finding that a relator
who had been approached by a government investigator did not voluntarily disclose
his findings); Prather v. AT&T, Inc., 847 F.3d 1097, 1108 (9th Cir. 2017) (party was
found to not have voluntarily disclosed information after his employer told him to
report it to the government).
2. Ellis is not an original source.
a. Arguments in separate provider cases do not give Ellis original source status.
Appellees make much of the fact that the State argued that Ellis was an original
source in cases she brought against dental providers. Appellees’ Br. 48-51. As the
State explained in its opening brief, Ellis named several providers in her qui tam
petition. Appellant’s Br. 41-42 (citing C.R.7668-71); C.R.173; CR.3129. While the
State intervened in those cases and defended Ellis as a relator, its decision to do so
did not confer original source status on Ellis with respect to the State’s Xerox
allegations. Appellant’s Br. 41-42 (citing Rockwell Intern., 549 U.S. at 476).
Even if State had previously taken the position that Ellis was an original source
in the Xerox case (which it did not do) the State is not estopped from now challenging
16 her status as an original source. See Tex. Gov’t Code 402.004; see also S.A.P., 156
S.W.3d at 577; Durham, 860 S.W.2d at 67; Prasifka, 450 S.W.2d at 835.
b. Ellis’s disclosures to the State do not establish her as an original source.
Appellees identify two disclosures made by Ellis to the State, but neither
establishes her as an original source. First, Appellees argue that “in 2011 [Ellis]
urged OIG to investigate Xerox, and was rebuffed.” Appellees’ Br. 50. To qualify as
an original source, Ellis was required to provide “information on which the
allegations are based” or provide information that “materially adds to the publicly
disclosed allegations.” Tex. Hum. Res. Code § 36.113(b). Merely “urging OIG to
investigate” Xerox satisfies neither. This alleged “urging” does not provide any
“information” at all.
Second, Appellees state that Ellis “starting in January 2012, urg[ed] Senator
Nelson’s committee to investigate Xerox and its policy of rubber-stamp approval.”
Appellees’ Br. 50 (citing Feb. 7, 2012, email). That email, however, fails to provide
any information that satisfies the “original source” requirement. See CR.6660.
Instead, based on the orthodontic claims Texas Medicaid hired her to review, Ellis’s
email to the Senator states that Xerox “missed this scoring issue” and surmises that
“I don’t think they even looked at the scoring sheet.” Id. She guesses that “[t]here
had to have been a rubber stamp approval” process, noting that “[t]here have been
17 rumors of an unofficial policy [at Xerox] authorizing all orthodontics” claims. Id. She
notes that “both the OIG representative and I independently came to the conclusion
that these billed codes have to be allowed due to a technicality in the way that the
medicaid manu[a]l is written.” Id. “I would suggest that your committee find out
who is responsible for writing the orthodontic part of the medicaid manu[a]l.” Id.
She questions “[d]id they actually get the dental director approval or just rubber
stamp that too?” Id. At best, the evidence shows that Ellis urged Senator Nelson’s
office to continue investigating Xerox to get to the bottom of the issue, but there is
no evidence that Ellis provided Senator Nelson’s committee with information on
which the eventual allegations against Xerox were based or that materially added to
the publicly disclosed allegations. Tex. Hum. Res. Code § 36.113(b).
Appellees make much of the fact that Ellis “suggested that WFAA investigate
ACS/Xerox” and that Ellis provided reporter Byron Harris “both factual
information and expert analysis.” Appellees’ Br. 50, 9. Any information Ellis
provided Byron Harris at WFAA is irrelevant to an original source analysis, as the
statute makes clear that the information at issue must be provided to the State. See
Tex. Hum. Res. Code § 36.113(b). Appellees’ argument that Ellis is an original
source because she provided information to Byron Harris at WFAA must be
rejected.
18 Appellees state that Ellis was hired by HHSC-OIG to investigate orthodontic
fraud “[a]s a result of one of her appearances on WFAA.” Appellees’ Br. 9. Both of
Ellis’s alleged disclosures to the State, however, occurred after she was retained as
a contractor. C.R.7495 (136:10-12) (stating that disclosure to Dr. Alfaro at HHSC-
OIG occurred “while I was a contractor. I would say it was multiple times during the
time period I was a contractor. But I can’t tell you an exact date”). Because Dr.
Ellis’s disclosures to the State occurred after she was contracted to investigate fraud,
her disclosures cannot be “voluntary.” Little v. Shell Expl. & Prod. Co., 690 F.3d 282,
294 (5th Cir. 2012) (stating that “the fact that a relator ‘was employed specifically
to disclose fraud is sufficient to render his disclosures nonvoluntary’”).
In sum, as the State explained in its opening brief (at 37-42), Ellis is not an
original source because she did not have “direct and independent” knowledge, and
the information was not “voluntarily provided” because Texas Medicaid retained
her as a contractor. Ellis is barred from being an original source for the additional
reason that she failed to disclose to the State “information on which the allegations
are based” or information that “materially adds to the publicly disclosed
allegations.” Tex. Hum. Res. Code § 36.113(b).
19 III. LaFountain and Ellis Are Barred by the TMFPA’s First-to-File Bar.
A. The Third Court of Appeals Did Not Rule on the Merits of the First-to-File Bar.
LaFountain and Ellis are barred by first-to-file because their allegations were
set forth in the earlier Alvarez petition. Appellees argue that the Third Court of
Appeals ruled on the merits of the first-to-file bar when the State appealed its plea to
the jurisdiction (at 51) but that is wrong. The State’s plea to the jurisdiction argued
that the Court lacked jurisdiction to adjudicate LaFountain and Ellis’s entitlement
to a relator share. C.R.2596-2623. The trial court denied the plea, and the Third
Court of Appeals affirmed, concluding “that the trial court has subject matter
jurisdiction to adjudicate the merits of [Appellees’] joint motion.” Ellis, 681 S.W.3d
at 504.
While the “TMFPA . . . contemplates a fact-intensive inquiry by the trial
court to determine whether the [first-to-file bar] appl[lies],” id. at 514, the Third
Court of Appeals did not perform such an inquiry. Indeed, the Third Court of
Appeals quoted the trial court in ruling that “[w]hether and to what percent—
whether any relator is entitled at all or what percentage of any relator share each of
these relators may be entitled to is a question that the parties in this case can decide
by agreement or I will decide at the appropriate time after proper argument and
briefing and all of that.” Id. at 510 n.7. “At this stage of the case … even if we were
20 to conclude that the first-to-file bar is jurisdictional, we would conclude that the
State did not conclusively establish that [Appellees’] qui tam actions were barred by
the first-to-file provision.” Ellis, 681 S.W.3d at 516 (emphasis added). In other
words, the Court held that because the trial court had yet to conduct a fact-intensive
inquiry, the State could not “conclusively” establish that the first-to-file bar applied
“at this stage of the case.” Id. Instead of ruling on the merits of the first-to-file issue,
the Court of Appeals held that there was a fact question that defeated the plea to the
jurisdiction. Id.
B. LaFountain’s Mention of Xerox’s Activity-Based Compensation Program Cannot Avoid the First-to-File Bar.
LaFountain is barred by the first-to-file bar because the fraudulent scheme
alleged in his petition was already alleged by Alvarez. Appellees point to a single
sentence in LaFountain’s 26-page petition that they contend avoids the bar:
“Defendant ACS amazingly had in place an ‘activity based compensation’ [“ABC”]
program, meaning the people processing the claims were paid by the number of
claims processed, so they had no incentive to closely analyze and reject False
Claims!” Appellees’ Br. 56 (citing CR.6338-39). Reference to Xerox’s ABC
program, however, merely provides an additional detail relating to the same
fraudulent scheme described in Alvarez’s petition. Without the allegations already
included in the Alvarez petition, the fact that Xerox provided financial incentives for
21 employees to review claims quickly is not indicative of fraud—it is simply an
“additional or somewhat different fact[] or information” that cannot survive the
first-to-file bar. United States ex rel. Heath v. AT & T, Inc., 791 F.3d 112, 121 (D.C.
Cir. 2015) (quoting United States ex rel. Hampton v. Columbia/HCA Healthcare Corp.,
318 F.3d 214, 217 (D.C. Cir. 2003)); see also United States ex rel. Wood v. Allergan,
Inc., 899 F.3d 163, 168-69 (2d Cir. 2018) (broader or more detailed allegations
insufficient to overcome first-to-file bar).
Appellees argue (at 57) that ABC “prevented [Xerox employees] from
properly reviewing all authorization requests,” but that is not what LaFountain
alleged. LaFountain alleged that, while Xerox employees “had no incentive to
closely analyze and reject” claims, there was never any allegation that ABC
prevented them from reviewing those claims accurately or appropriately. See
CR.6338-39. ABC merely “incentivized employees to process more [prior
authorization] requests in less time.” CR.4422 ¶21. Indeed, the fact that Xerox
incentivized the fast review of claims is not—by itself—an allegation that targets a
factually distinct type of fraud, or for that matter, any type of fraud at all.
Appellees rely heavily on Heath, but that case involved two complaints that
targeted factually distinct types of frauds. 791 F.3d 121. In Heath, the second
complaint alleged “a different and more far-reaching scheme to defraud the federal
22 government through service contracts entered into across the Nation, and then to
cover up that fraud.” Id. In contrast, the first “complaint discloses nothing more
than the rogue actions of individuals within a single AT&T subsidiary and their
specific, overt misrepresentations.” Id. at 121-22. “Nothing in the [first] complaint
would have alerted the United States government to a nationwide scheme centered
in AT&T’s corporate headquarters of mischarging the E–Rate program and
subsequently concealing those overpayments.” Id. at 122. Heath is distinguishable
because Xerox’s ABC program is not a distinct fraudulent scheme. It is simply
additional information that cannot survive a first-to-file challenge. See id. at 121.
Appellees point out (at 56) that the State described the ABC program in its
own TMFPA petition. That the State included a description of the ABC program in
its lawsuit against Xerox does not affect the Court’s analysis, because the existence
of the ABC program—standing alone—is not indicate of any kind of fraud.
Regardless, as Appellees concede (at 52), the allegations in the State’s petition are
irrelevant as “first-to-file challenges are decided by comparing the four corners of
the [Alvarez and LaFountain] petitions alone”—and not by reference to the State’s
petition.
Finally, Appellees do not dispute that even before LaFountain filed his
petition, Alvarez sent a letter to the State disclosing that Xerox had an “activity
23 based compensation” plan that paid employees “based upon the
number of claims processed.” CR.3941. Instead, Appellees argue (at 57) that
Alvarez’s disclosure letter cannot legally bar a later-filed petition, but Appellees miss
the point. The disclosure letter proves that Alvarez was aware of the ABC program
when she drafted her petition. If ABC was a distinct allegation of fraud, as Appellees
suggest, Alvarez surely would have included it in her petition. The fact that she did
not supports the State’s position that it was merely “additional information”
insufficient to overcome a first-to-file challenge.
C. The Two Allegations in Ellis’s Petition Identified by Appellees Are Not Distinct Allegations of Fraud.
Appellees identify two allegations in Ellis’s petition that they contend survive
the first-to-file bar. First, Alvarez alleged that Xerox used unqualified and untrained
staff to review claims “for cosmetic braces and children under 12.” Appellees’ Br.
58. Appellees contend that only Ellis alleged that Xerox used unqualified and
untrained staff to review “every request … regardless of whether they were for
cosmetic braces or children under 12.” Id. at 58. The Alvarez petition, however,
succinctly conveys that the unqualified and untrained Xerox staff was reviewing all
the claims they were contracted to review, not just claims for cosmetic braces and
children under 12. See CR.3913 (¶ 29) (“The claims that are submitted are processed
by Defendant ACS [Xerox].”); CR.3923 (¶ 51) (alleging that ACS contracted with
24 HHSC “to process Medicaid claims”). The Alvarez petition does not imply, as
Appellees suggest, that different Xerox staff was reviewing the remainder of the
dental claims. Thus, the Alvarez petition discloses precisely the information
Appellees claim is distinct in Ellis’s petition. Moreover, even if Alvarez had not
disclosed the fact that the same Xerox staff reviewed all orthodontic claims, that is
simply additional information relating to the same fraudulent scheme alleged by
Alvarez. It is not a distinct allegation of fraud sufficient to survive a first-to-file
challenge. United States ex rel. Branch Consultants v. Allstate Ins. Co., 560 F.3d 371,
378 (5th Cir. 2009).
Second, Appellees argue that only Ellis alleged that Xerox “misrepresented
material facts and knowingly concealed” from the State the fraud alleged in
Alvarez’s petition. Appellees’ Br. 58. In other words, while Alvarez fully explained
that Xerox was defrauding the State, Ellis made the unremarkable claim that Xerox
lied about, and concealed, that very same fraud from the State, which is a fact that is
almost certainly true in every Medicaid fraud case and could be easily inferred when
reading the Alvarez petition. Again, Appellees argue (at 59) that the State included
these same facts in its own TMFPA petition. (The language cited by Appellees is
taken directly from the TMFPA itself. See Tex. Hum. Res. Code §§ 36.002(1), (2).)
Regardless, while the State’s petition may have included some of the same facts that
25 were also in the Ellis petition, their inclusion does not change the fact that Ellis must
show these facts are distinct element of fraud and not merely additional information.
Even Appellees concede (at 52) that “first-to-file challenges are decided by
comparing the four corners of the [Alvarez, LaFountain, and Ellis] petitions alone.”
In sum, neither of the two Ellis allegations are “distinct allegations of fraud”
because both rely on the same facts underlying the Alvarez petition. Tex. Hum. Res.
Code § 36.106; see also Cho ex rel. States v. Surgery Partners, Inc., 30 F.4th 1035, 1044
(11th Cir. 2022) (barring a second-filed complaint that did not “meaningfully
magnify the scope or pervasiveness of the scheme”). “[T]he government was
already alerted to that scheme, and would have been equipped to investigate” the
additional allegations in the second-filed compalint. Id.
IV. The TMFPA Does Not Authorize Awarding Interest Against the State.
When a statute such as the TMFPA creates a cause of action, remedies are
limited only to what is specifically provided for in the statute. Matter of Ament, 890
S.W.2d 39, 41 (Tex. 1994) (per curiam). While not provided by the TMFPA, the trial
court nevertheless awarded Appellees $11,044,503.70 in prejudgment interest.
C.R.9534. This was error.
Appellees agree that they are not entitled to statutory prejudgment interest,
but argue they are entitled to equitable prejudgment interest, relying heavily on
26 Cavnar v. Quality Control Parking, Inc., 696 S.W.2d 549 (Tex. 1985). Appellees’ Br.
60. Cavnar, however, involved awarding prejudgment interest in a common-law
negligence case. 696 S.W2d at 554. Cavnar based its prejudgment interest holding
on the “primary objective of awarding damages in civil actions” which is “to
compensate the injured plaintiff, rather than to punish the defendant.” Id. at 552
(citing W. Keeton, et al., Prosser and Keeton on the Law of Torts § 2 (5th ed. 1984)).
But the TMFPA is not a damages statute. In re Xerox Corp., 555 S.W.3d 518, 526-27
(Tex. 2018) (orig. proceeding) (holding that TMFPA remedies “are not damages”).
Accordingly, Cavnar does not apply.
Appellees also rely on Origin Bank v. Castellano, No. 4:21-CV-02173, 2024
WL 169664 (S.D. Tex. Jan. 12, 2024), but like Cavnar, that case involved common-
law causes of action for damages. In addition to violations of the Texas Theft
Liability Act, the plaintiff alleged conspiracy to commit bank fraud, conversion, and
common-law fraud. Origin Bank, 2024 WL 169664, at *1. There are no common law
fraud claims – or any other equitable claims – in this case.
Appellees likewise rely upon Morgan v. Ebby Halliday Real Estate, Inc., but this
case does not aid them either. 873 S.W.2d 385 (Tex. App.—Fort Worth 1993, no
writ). The plaintiffs in Morgan were awarded prejudgment interest under a statute
that, unlike the TMFPA, explicitly provided for prejudgment interest. “Under this
27 statute, ‘prejudgment interest accrues on the amount of the judgment during the
period beginning on the 180th day after the date the defendant receives written
notice of a claim or on the day the suit is filed, whichever occurs first, and ending on
the day preceding the date judgment is rendered.’” Id. at 387 (citing Tex. Rev. Civ.
Stat. art. 5069–1.05 § 6(a)).
Appellees cite Bituminous Casualty Corp. v. Vacuum Tanks, Inc., 75 F.3d 1048
(5th Cir. 1996), as holding that “under Texas law an equitable award of prejudgment
interest should be granted to a prevailing plaintiff in all but exceptional
circumstances.” Appellees’ Br. 60. Bituminous holds that, consistent with Cavnar,
prejudgment interest is awarded “when the trier of fact finds that damages accrued.”
Id. at 1057 (emphasis added). Damages cannot accrue here since the TMFPA does
not award damages. Xerox, 555 S.W.3d at 526-27, 535; Nazari v. State, 561 S.W.3d
495, 509-10 (Tex. 2018).
Finally, Appellees cite State Department of Highways and Public Transportation
v. Bacon, 754 S.W.2d 279 (Tex. App.—Texarkana 1988, writ denied), for the
proposition that prejudgment interest is available against the State even when not
provided for in the asserted statute. Appellees’ Br. 61. Bacon relies on the “general
rule laid down in Cavnar . . . [that] prejudgment interest is recoverable on a wrongful
death claim against a private person.” 754 S.W.2d at 282. Just as this TMFPA matter
28 is distinguishable from Cavnar, it is also distinguishable from Bacon, since this matter
does not involve wrongful-death claims, personal-injury claims, or damages. Id. at
280. The holding in Bacon was unique since it concerned specifically whether the
State was liable for prejudgment interest under the Texas Tort Claims Act. Id. at
282. Because the Texas Tort Claims Act did not lay out an “exact compensation
scheme,” but merely put a cap on total recovery, the Bacon court found the statute
did allow for prejudgment interest. Id. Unlike the Tort Claims Act, the TMFPA does
lay out an exact compensation scheme afforded to relators. See, e.g., Tex. Hum. Res.
Code § 36.110(c) (providing a specified range of statutory recovery plus “reasonable
expenses, reasonable attorney’s fees, and costs that the court finds to have been
necessarily incurred”). Thus, Bacon does not apply here.
V. Because LaFountain and Ellis Are Not “Original Sources” They Are Not Entitled to a 0-7% Fee Determination.
A relator barred by public disclosure is entitled to a 0-7% fee determination
under Section 36.110(b) only if proven to be an “original source.” LaFountain and
Ellis are not “original sources,” and even if they were, they are barred by the first-
to-file doctrine. (Alvarez does not claim to be an “original source.” Appellees’ Br.
44.) As a result, Appellees are not entitled to a 0-7% fee determination.
Appellees argue that they are entitled to a 0-7% award even if they “were not
original sources.” Appellees’ Br. 65. This misstates the law. Courts interpreting the
29 analogous provision under the FCA, 31 U.S.C. § 3730(d)(1), consistently hold that
this fee award is only available to relators who are deemed to be “original sources.”
See Fed. Recovery Servs., Inc. v. United States, 72 F.3d 447, 452 (5th Cir. 1995) (noting
that Congress included that provision to provide for “the case where the information
has already been disclosed and the person qualifies as an ‘original source’ but where
the essential elements of the case were provided to the government or news media
by someone other than the qui tam plaintiff.”); United States ex rel. Merena v.
SmithKline Beecham Corp., 114 F. Supp. 2d 352, 361 (E.D. Pa. 2000) (allowing for a
fee determination where there is “a prior public disclosure” from “an otherwise
properly qualified ‘original source’”). Otherwise a “relator whose claim is subject
to dismissal under section 3730(e)(4) [the FCA public disclosure bar] may not
receive any share of the proceeds attributable to that claim.” Merena v. SmithKline
Beecham Corp., 205 F.3d 97, 106 (3d Cir. 2000).
Here, because Alvarez has conceded that she is not an original source,
LaFountain and Ellis must establish both that they are original sources and that they
can survive the first-to-file bar before Appellees may recover under
Section 36.110(b). Appellees rely upon United States ex rel. Burke v. St. Jude Med.,
Inc., No. CV 16-3611-SAG, 2021 WL 6135202 (D. Md. Dec. 29, 2021) for the
assertion that “had [relator] been an original source, she could have been awarded a
30 15% ‘finder’s fee’.” Appellee’s Br. 65. But the Burke court held that relator was an
“original source” before awarding her a nominal 0.5% share. Burke, 2021 WL
6135202 at *7-8.
Even if LaFountain and Ellis were found to be “original sources,” Appellees
fail to present any evidence that either provided significant information or played a
role in advancing State v. Xerox to litigation that could justify even a nominal award
under Section 36.110(b). Appellees argue (at 65) that Ellis “met with and trained the
attorneys from the Attorney General’s Office,” but that meeting occurred on
February 10, 2014—over two years after the State began investigating Xerox’s
conduct. CR.3357. Appellees argue (at 64) that Ellis “repeatedly encouraged” the
State to pursue Xerox, but again, this occurred after the State began investigating
Xerox and after the State hired Ellis to review orthodontic claims when Xerox’s
fraud became publicly disclosed. C.R.8647-53. Moreover, this “catalyst” theory—
that a relator is entitled to a share because it “encouraged” the government to pursue
claims—has been repeatedly rejected by courts in the FCA context and should be
rejected here. See United States ex rel. Hays v. Hoffman, 325 F.3d 982, 990 (8th Cir.
2003); United States ex rel. Montgomery v. St. Edward Mercy Med. Ctr., No. 4:05-cv-
00899, 2007 WL 2904111, at *9 (E.D. Ark. Sept. 28, 2007); United States ex rel.
Findley v. FPCBoron Emps.’ Club, 105 F.3d 675, 688 (D.C. Cir. 1997) (“a relator’s
31 ability to recognize the legal consequences of a publicly disclosed fraudulent
transaction does not alter the fact that the material elements of the violation already
have been publicly disclosed.”); United States ex rel. Karadsheh v. Fata, No. 2:13-cv-
13333, 2019 WL 6702141, at *3 (E.D. Mich. Dec. 9, 2019); United States ex rel. Rille
v. PriceWaterhouseCoopers LLP, 803 F.3d 368, 374 (8th Cir. 2015).
In sum, Appellees are not “original sources” and even if they were, they did
not provide significant information or play a role in advancing State v. Xerox to
litigation and are therefore not entitled to any relator’s share.
32 PRAYER
For the reasons above, the State respectfully requests that this Court reverse
and either dismiss the underlying action or render judgment that Appellees are not
entitled to a relator’s share of the State v. Xerox settlement.
Respectfully submitted,
KEN PAXTON /s/ Austin Kinghorn Attorney General of Texas AUSTIN KINGHORN Deputy Attorney General for Civil BRENT WEBSTER Litigation First Assistant Attorney General Texas State Bar No. 24072184 Phone: (512) 936-1180 RALPH MOLINA Austin.Kinghorn@oag.texas.gov Deputy First Assistant Attorney General BRIAN VANDERZANDEN AMY SNOW HILTON Assistant Attorney General Chief, Healthcare Program Enforcement Texas State Bar No. 24081557 Division Phone: (512) 936-9929 Brian.Vanderzanden@oag.texas.gov Office of the Attorney General P.O. Box 12548, MC 056-1 Counsel for Appellant State of Texas Austin, Texas 78711-2548 Tel: (512) 750-4880 Fax: (512) 499-0712
33 CERTIFICATE OF COMPLIANCE
I certify that this document complies with the typeface requirements of Tex.
R. App. P. 9.4(e) because it has been prepared in a conventional typeface no smaller
than 14-point for text and 12-point for footnotes. This document also complies with
the word-count limitations of Tex. R. App. P. 9.4(i), because it contains 7,307 words,
excluding any parts exempted by Tex. R. App. P. 9.4(i)(1).
/s/ Austin Kinghorn AUSTIN KINGHORN Deputy Attorney General for Civil Litigation
34 Automated Certificate of eService This automated certificate of service was created by the efiling system. The filer served this document via email generated by the efiling system on the date and to the persons listed below. The rules governing certificates of service have not changed. Filers must still provide a certificate of service that complies with all applicable rules.
Lynette Karch-Schroder on behalf of Austin Kinghorn Bar No. 24072184 Lynette.karch-schroder@oag.texas.gov Envelope ID: 106381794 Filing Code Description: Brief Requesting Oral Argument Filing Description: Reply Brief for Appellant Status as of 10/2/2025 3:03 PM CST
Associated Case Party: Christine Ellis
Name BarNumber Email TimestampSubmitted Status
Caitlyn Silhan 24072879 csilhan@waterskraus.com 10/2/2025 2:56:47 PM SENT
James Moriarty 14459000 jim@moriarty.com 10/2/2025 2:56:47 PM SENT
Charles S.Siegel csiegel@waterskraus.com 10/2/2025 2:56:47 PM SENT
Associated Case Party: State of Texas
Name BarNumber Email TimestampSubmitted Status
Brian Vanderzanden brian.vanderzanden@oag.texas.gov 10/2/2025 2:56:47 PM SENT
Jonathan Rohde jonathan.rohde@oag.texas.gov 10/2/2025 2:56:47 PM SENT
Brittany Peters Brittany.Peters@oag.texas.gov 10/2/2025 2:56:47 PM SENT
Lynette Karch-Schroder lynette.karch-schroder@oag.texas.gov 10/2/2025 2:56:47 PM SENT
Austin Kinghorn 24072184 austin.kinghorn@oag.texas.gov 10/2/2025 2:56:47 PM SENT
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