United States Ex Rel. Davis v. District of Columbia

773 F. Supp. 2d 21, 2011 U.S. Dist. LEXIS 32956, 2011 WL 1126048
CourtDistrict Court, District of Columbia
DecidedMarch 29, 2011
DocketCivil Action 06-0629 (JDB)
StatusPublished
Cited by6 cases

This text of 773 F. Supp. 2d 21 (United States Ex Rel. Davis v. District of Columbia) is published on Counsel Stack Legal Research, covering District Court, District of Columbia 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. Davis v. District of Columbia, 773 F. Supp. 2d 21, 2011 U.S. Dist. LEXIS 32956, 2011 WL 1126048 (D.D.C. 2011).

Opinion

MEMORANDUM OPINION

JOHN D. BATES, District Judge.

Plaintiff Michael L. Davis (“plaintiff’ or “relator”) brings this qui tam action on behalf of the United States under the False Claims Act, 31 U.S.C. §§ 3729 et seq. (“FCA” or “the Act”), alleging that the District of Columbia (“the District” or “defendant”) and the District of Columbia Public Schools (“DCPS”) violated the Act by submitting a Medicaid reimbursement claim for fiscal year 1998 without maintaining adequate supporting documentation. Presently before the Court are [87] plaintiffs motion for summary judgment, and [88] the District’s motion to dismiss or, in the alternative, for summary judgment. Because plaintiffs claims are based upon a “public disclosure” and plaintiff does not qualify as an “original source” under the language of the FCA in effect at the relevant time, the Court will grant defendant’s motion to dismiss for lack of subject matter jurisdiction.

BACKGROUND

In 1995, the District awarded a contract to Health Management Systems (“HMS”) *23 to design and implement a Medicaid Reimbursement Recovery Program for the DCPS Special Education Program. Am. Compl. [Docket Entry 82] ¶ 10. Plaintiffs firm, Davis & Associates (“D & A”), worked as a subcontractor to HMS. Id. ¶¶ 4, 11. As a HMS subcontractor, D & A was responsible for collecting data, maintaining necessary documentation, and preparing Medicaid reimbursement claims (“cost claims”) for the services that DCPS provided to special education students. Id. ¶ 11. At the end of 1998, the District told D & A that the D & A/HMS contract would not be renewed, and that it had hired Maximus Corporation (“Maximus”) to prepare future DCPS cost claims. Id. ¶ 12; see also Personal Disclosure Statement of Michael L. Davis (“Personal Disclosure Statement”) at 1. D & A still prepared the cost claim for fiscal year 1998, totaling approximately $67 million, which it submitted to DCPS in June 1999. See Am. Compl. ¶¶ 13-14; Def.’s Mot. to Dismiss or for Summ. J. (“Def.’s Mot.”) [Docket Entry 88], Ex. A. D & A retained all of the documentation needed to substantiate the 1998 cost claim. Am. Compl. ¶ 14.

Shortly after receiving D & A’s cost claim, Donald Rickford, the Chief Financial Officer of DCPS, told D & A that he would not be forwarding the cost claim to the Medical Assistance Administration (“MAA”) for reimbursement given the “substantial amount of work that remains to be done on the project.” Def.’s Mot., Ex. B. According to Rickford, the D & A cost claim did not “effectively capture outstanding moneys due to DCPS because of the lack of documentation provided and the methodology used.” Id. Rather than submit the D & A cost claim to MAA, DCPS asked Maximus to prepare another cost claim for fiscal year 1998. Am. Compl. ¶ 15. In or around January 2000, DCPS submitted the revised Maximus cost claim — in the amount of approximately $11 million — to MAA. Id.; see also Pl.’s Opp. to Def.’s Mot. to Dismiss or for Summ. J. (“PL’s Opp.”) [Docket Entry 90], Ex. A (“Maximus FY 98 Cost Report”). 1

Medicaid is funded jointly by states and the federal government, and MAA is the state agency that administered the District’s Medicaid program at the time relevant to this suit. See Def.’s Mot., Ex. D (“CMS Report”) at 3. During this time-period, MAA submitted quarterly reports to the Centers for Medicare and Medicaid Services (“CMS”), the federal agency that oversees all state Medicaid programs. Id. These reports set forth the District’s Medicaid expenditures — including those of DCPS — as well as the District’s claim for the federal portion of Medicaid reimbursement, known as Federal Financial Participation (“FFP”). Id. The services that DCPS provides to special needs children pursuant to Individualized Education Plans fall under the Medicaid coverage category of “clinic services,” meaning that DCPS is reimbursed for the cost of these services on an interim basis throughout the year. See id. at 4; see also Def.’s Mot., Ex. C (“District Medicaid State Plan”) at 10. However, at the end of each *24 fiscal year, DCPS would submit a cost claim to MAA — ie., the Maximus FY 98 Cost Report at issue here — which would “allow MAA to determine what DCPS’s actual costs were for providing the services that were already billed and paid on an interim basis.” CMS Report at 4; Am. Compl. ¶ 13.1.

MAA would then work with an auditing firm to review and validate the annual DCPS cost claim so that only allowable costs would be included in the final cost settlement. See CMS Report at 4; see also District Medicaid State Plan at 11. Once MAA and its auditors computed DCPS’s actual, recoverable costs, MAA would reconcile these costs with the interim payments that had already been made, and refund the federal share of any overpayment to CMS through a credit on the District’s quarterly report. See CMS Report at 4-6; 42 C.F.R. § 433.320; Def.’s Mot., Ex. E (“2002 Audit”) at 8 (explaining that “MAA will review or audit the cost report no less than once every two years, determine DCPS’ final actual and reasonable costs, and complete the settlement by paying the balance due to DCPS or collecting the amount owed by DCPS”).

When D & A learned that DCPS had submitted the Maximus FY 98 Cost Report to MAA, it contacted Rickford to inform him that Maximus lacked the requisite documentation to support the cost claim, since the documentation was still in D & A’s possession. See Am. Compl. ¶ 16; Personal Disclosure Statement at 2. D & A also told Rickford that the $11 million Maximus cost claim did not reflect the full amount of Medicaid reimbursement owed to DCPS. Am. Compl. ¶ 16. According to plaintiff, Rickford and another District official assured D & A that the Maximus cost claim would be corrected and re-submitted by September 2001. Id. ¶ 17. However, no corrected cost claim was ever submitted. Instead, in May 2000, MAA paid DCPS $10,335,893 in FFP funds as a “tentative settlement determination of program reimbursement” for the 1998 fiscal year, and informed DCPS that the payment would be adjusted after MAA’s auditor, Bert Smith and Company (“Bert Smith & Co.”), had finished reviewing DCPS’s cost information for fiscal years 1996 through 1998. See Pl.’s Opp., Ex. C; see also PL’s Mot. for Summ. J. (“PL’s Mot.”) [Docket Entry 87], Ex. G (same); Am. Compl. ¶ 20.1.

Bert Smith & Co. did not complete its review of DCPS’s 1996-1998 Medicaid cost information until 2001. See 2002 Audit at ii; see also PL’s Mot., Ex. H (“Bert Smith & Co. Reports”) at 2, 16. Because DCPS lacked certain requested information, Bert Smith & Co.

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Related

United States v. DC
793 F.3d 120 (D.C. Circuit, 2015)
United States Ex Rel. Davis v. District of Columbia
34 F. Supp. 3d 30 (District of Columbia, 2014)
Davis v. United States Department of Health & Human Services
968 F. Supp. 2d 176 (District of Columbia, 2013)

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Bluebook (online)
773 F. Supp. 2d 21, 2011 U.S. Dist. LEXIS 32956, 2011 WL 1126048, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-davis-v-district-of-columbia-dcd-2011.