United States Ex Rel. Gudur v. Deloitte Consulting LLP

512 F. Supp. 2d 920, 2007 U.S. Dist. LEXIS 18297, 2007 WL 836935
CourtDistrict Court, S.D. Texas
DecidedMarch 15, 2007
DocketCivil Action H-00-1169
StatusPublished
Cited by10 cases

This text of 512 F. Supp. 2d 920 (United States Ex Rel. Gudur v. Deloitte Consulting LLP) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas 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. Gudur v. Deloitte Consulting LLP, 512 F. Supp. 2d 920, 2007 U.S. Dist. LEXIS 18297, 2007 WL 836935 (S.D. Tex. 2007).

Opinion

*921 MEMORANDUM OPINION AND ORDER

SIM LAKE, District Judge.

Pending in this qui tam action brought under the False Claims Act (FCA), 31 U.S.C. § 3729 et seq., 1 are the Motion for *922 Summary Judgment (Docket Entry No. 678) filed by defendant Deloitte Consulting LLP (Deloitte) and two motions for partial summary judgment filed by Plaintiff-Relator, Ramesh Gudur: Relator’s Motion for Partial Summary Judgment (Time Survey v. Time Study) (Docket Entry No. 679), and Relator’s Motion for Partial Summary Judgment (Indirect Cost) (Docket Entry No. 680). Also pending is Deloitte’s Motion to Strike the Statement of Interest of the United States Regarding Deloitte’s Motion for Summary Judgment (Docket Entry No. 789). For the reasons set forth below, Deloitte’s motion for summary judgment and motion to strike will be granted, and Relator’s motions for partial summary judgment will be denied.

I. Background

A. Procedural Background

The procedural history of this case can be found in the court’s prior orders. (Docket Entry Nos. 202, 237, 283, 344, 395, 501) Only Relator’s claims against Deloitte Consulting, LLP (“Deloitte”) remain. The claims against Deloitte are based on allegations that Deloitte caused false Medicaid claims to be submitted to the United States Government, and that Deloitte conspired with certain Texas school districts to inflate Medicaid reimbursement rates in violation of the FCA. See Relator’s Third Amended Complaint (Docket Entry No. 397) and the court’s August 31, 2004, Memorandum and Order (Docket Entry No. 501).

B. Factual Background

1. Undisputed Facts

(a) General Facts

By federal mandate Texas school districts must provide a free and appropriate public education to all children. This includes the provision of free health-related services needed to help special education students achieve the goals set forth in their Individual Education Plans. For many years the obligation to provide free health related services was an unfunded mandate. However, in January of 1989 passage of the Medicare Catastrophic Coverage Act of 1988, Public Law 100-360 (1988) required the federal government to make Medicaid reimbursement available to qualified providers of health-related services for special education children in the school setting. This law became effective in January of 1989. (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at pp. 43-44.)

In October of 1990 the State of Texas submitted for federal approval the first proposed State Plan Amendment (SPA) to include coverage for the School Health and Related Services (SHARS) program. (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at pp. 43-44.)

In September of 1992 the SPA creating the SHARS program received federal approval. The SHARS program allowed school districts to claim Medicaid reimbursement for nine health-related services: occupational, physical, and speech therapy; medical, school health, and psychological services; assessments; audiology; and counseling. (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at pp. 43-44.) In October of 1992 the National Heritage Insurance Company (NHIC), the government’s designated claims facility, began accepting provider applications from local school districts and special education cooperatives, *923 and in November of 1992 NHIC began accepting claims for reimbursement under the SHARS program. The SPA provided that SHARS reimbursement rates would be based on cost data gathered in a 1999 study by the Texas Interagency Council on Early Childhood Development until a new cost study could be completed. Provided that adequate documentation was available, school districts could claim reimbursement for services back to December of 1991. (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at pp. 43^44.)

In June and July of 1993 the Medicaid operating agency gathered cost data for the purpose of establishing SHARS-specific reimbursement rates. In September of 1993 House Bill 7 shifted responsibility for administration of the SHARS program from the Texas Department of Human Services (DHS) to the Texas Department of Health (TDH). However, DHS maintained responsibility for determining Medicaid eligibility. (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at p. 44.) Before the cost data was compiled and analyzed, TDH determined that the data was inadequate and obsolete.

In April of 1994 the State of Texas received federal approval for a second SPA to include special transportation as a (tenth) reimbursable service. In April of 1994 Deloitte began working with the Texas Education Agency (TEA) to establish new SHARS reimbursement rates based upon: (1) cost data gathered in 1993; (2) time data gathered by Deloitte in 1994; and (3) financial information relating to special education expenditures for all school districts in the state maintained by the TEA. This effort resulted in rates that ranged between 13 percent and 164 percent (an average of 98%) higher than the previously used rates. (See Staff. Performance Report to 74th Legislature, Docket Entry No. 678-7 at p. 48.) In August of 1994 Deloitte proposed new interim rates for nine of the ten SHARS services. In November of 1994 TDH approved and adopted four of the nine rates proposed by Deloitte (i.e., rates for assessment, psychological services, school health services, and speech therapy). TDH rejected the remaining five rates proposed by Deloitte (i.e., rates for audiology, counseling, medical services, occupational therapy, and physical therapy). (See Staff Performance Report to 74th Legislature, Docket Entry No. 678-7 at pp. 45 & n. 2, and 48-49.) In an October 20, 1994, letter to the TEA, Joseph Branton of the TDH explained that

[t]he department has chosen to use the rates proposed by Deloitte and Touche for school health services and speech therapy services as the rate increases appear reasonable and these services are the most frequently billed. The department has also chosen to use the rates proposed by Deloitte and Touche for assessment and psychological services in light of the resources required to perform the services.
While we agree that the remaining SHARS rates need to be revised, we are concerned about the insufficient data available to Deloitte and Touche to establish the revised rates. We are also concerned about the comparability of these rates to payment rates of other providers of these services and about the potential liability of the state and the department in the event of a HCFA [Health Care Financing Administration] audit. Therefore, the remaining SHARS rates are only being updated for inflation. We do .plan, however, to conduct our own cost study of the SHARS rates in the near future and will make future adjustments as necessary to reflect the costs of these services to the school districts.

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512 F. Supp. 2d 920, 2007 U.S. Dist. LEXIS 18297, 2007 WL 836935, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-gudur-v-deloitte-consulting-llp-txsd-2007.