United States ex rel. Carson v. Manor Care, Inc.

851 F.3d 293, 41 I.E.R. Cas. (BNA) 1666, 2017 WL 1032267, 2017 U.S. App. LEXIS 4617
CourtCourt of Appeals for the Fourth Circuit
DecidedMarch 16, 2017
DocketNo. 16-1035
StatusPublished
Cited by59 cases

This text of 851 F.3d 293 (United States ex rel. Carson v. Manor Care, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States ex rel. Carson v. Manor Care, Inc., 851 F.3d 293, 41 I.E.R. Cas. (BNA) 1666, 2017 WL 1032267, 2017 U.S. App. LEXIS 4617 (4th Cir. 2017).

Opinion

AGEE, Circuit Judge:

Patrick Gerard Carson filed a qui tam suit on behalf of the United States and several states under the False Claims Act (“FCA”) and the state equivalents, claiming that his employer, HCR Manor Care, and related companies, Manor Care, Inc. and Heartland Employment Services, LLC, (collectively, “Manor Care”) were ov-erbilling the respective governments for medical services. Carson included a separate claim of retaliation in his complaint, alleging that his employment was terminated after he notified his employer of the alleged overbilling. The district court dismissed the complaint in its entirety under the FCA’s. first-to-file rule. For the reasons below, we .affirm in part and vacate and remand in part.

I.

In January 2009, Christine A. Ribik filed a qui tam suit under seal in the Eastern District of Virginia on behalf of the United States against Manor Care.1 As a former occupational therapist for Manor Care’s nursing facilities, Ribik alleged that she “witnessed therapists and other staff members commit numerous offenses in violation of Medicare regulations, which give rise to violations of the False Claims Act.” J.A. 49. The complaint alleged that Manor Care inflated its revenues through over-billing Medicare for “skilled physical therapy and rehabilitation” costs. J.A. 52. Ri-bik claimed that Manor Care regularly and fraudulently classified its patients as needing more physical therapy than necessary and instructed its physical therapists to spend more time than needed with the patients, resulting in higher Medicare payments. She also alleged that Manor Care sent some patients to physical or occupational therapy who did not need it at all and refused to discharge patients for whom physical therapy was no longer useful. Ribik amended her complaint in April 2011.

In September 2011, Carson filed a qui tam suit under seal in the Eastern District of Virginia on behalf of the United States and several individual states2 against Manor Care under the FCA and the state-equivalent statutes. The suit sought

to recover on behalf of the Government damages and civil penalties arising from false or fraudulent claims that Defendants submitted or caused to be submitted to federal Government-funded health insurance programs for skilled nursing facility stays and the therapies administered during those stays to Government-funded health insurance including, but not limited to, Medicare, Medicaid, TRI-CARE/CHAMPUS and FEHBP beneficiaries.

J.A. 132. Carson alleged that Manor Care had committed fraud upon the government through its billing practices, including “(a) Overbill[ing] for therapy services provided; (b) Bill[ing] for therapy services not provided; (c) Billing] non-skilled activities as skilled therapy; and (d) Billfing] for unrea[301]*301sonable, unnecessary and at times harmful therapy.” J.A. 132. The complaint also alleged that Manor Care spent more time than necessary with patients to increase billing and “postponed the discharge of patients for days and sometimes weeks longer than medically appropriate.” J.A. 133. Carson claimed that he witnessed these practices while working for Manor Care’s nursing facilities as a physical therapist assistant.

Carson also made a claim of retaliation under the FCA, alleging that his “employment with [Manor Care] was terminated in November of 2009 due to his repeated complaints about the fraudulent billing practices concerning patients associated with Government funded health programs including, but not limited to, Medicare and Medicaid.” J.A. 163. The complaint stated that Carson informed management, human resources, and the corporate office of the “continued billing fraud” in February 2007 and multiple times in 2009, with a final complaint to Manor Care’s corporate compliance office in November 2009. J.A. 164. He was fired less than a week later. Manor Care .stated that Carson’s employment “was terminated for changing a plan of care in violation of [state law],” given that “only a physical therapist may change a treatment goal within a plan of care.” J.A. 164. Carson was not a licensed physical therapist. However, Carson claimed this reason was merely pretext, especially since “the goal changed by [Carson] was approved by the physical therapist, consistent with the practice utilized by [Manor Care].” J.A. 164.

Carson filed an amended complaint with twenty-five causes of action in May 2015; the only change from the original complaint was to remove certain defendants. Claims one through eight were qui tam claims under the FCA, including a conspiracy claim. The ninth was an FCA retaliation claim. The remaining causes of action were brought under the various state FCA-equivalent statutes.

Ribik and Carson’s cases were consolidated in June 2012, and a third case3 was added in November 2014. The United States Government filed a notice of election to intervene in the consolidated case in December 2014, and its “Consolidated Complaint in Intervention” was filed in April 2015. In July 2015, Manor Care filed a motion to dismiss the Government’s complaint, arguing that the complaint failed to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6) and was improperly pleaded under Federal Rule of Civil Procedure 9(b). The district court denied the motion.

Manor Care then filed a motion to dismiss Carson’s amended complaint. Among other arguments, Manor Care contended that the FCA and Michigan qui tam claims were barred by the first-to-file rule, and the FCA and all the state-equivalent qui tam claims, save the Wisconsin claim, were barred because they were based on public disclosure. Further, Manor Care argued that all claims failed because they were not “plausibly or sufficiently pleaded ... pursuant to Rules 12(b)(6) and 9(b).” J.A. 563. The district court granted the motion in December 2015 in a three-page order, concluding that Carson’s . complaint was “based upon the same material elements of alleged fraud” as Ribik’s complaint, and therefore the F.CA’s first-to-file rule barred all of Carson’s claims. J.A. 638. The court dismissed Carson’s complaint in its [302]*302entirety for lack of subject matter jurisdiction. Carson filed a timely notice of appeal, and we have jurisdiction pursuant to 28 U.S.C. § 1291.

II.

The Court reviews a dismissal for lack of subject matter jurisdiction and questions of statutory interpretation de novo. Wu Tien Li-Shou v. United States, 777 F.3d 175, 179 (4th Cir.), cert. denied, — U.S. -, 136 S.Ct. 139, 193 L.Ed.2d 42 (2015) (subject matter jurisdiction); Tankersley v. Almand, 837 F.3d 390, 395 (4th Cir. 2016) (statutory interpretation). “We may affirm on any grounds supported by the record, notwithstanding the reasoning of the district court.” Tankersley, 837 F.3d at 395.4

III.

Carson’s amended complaint alleged FCA qui tam claims, an FCA retaliation claim, and state fraud claims similar to an FCA qui tam claim. We address each in turn.

A.

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851 F.3d 293, 41 I.E.R. Cas. (BNA) 1666, 2017 WL 1032267, 2017 U.S. App. LEXIS 4617, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-carson-v-manor-care-inc-ca4-2017.