United States of America and the State of New York ex rel. J. Doe v. Community Living Corporation

CourtDistrict Court, S.D. New York
DecidedMay 14, 2020
Docket1:17-cv-04007
StatusUnknown

This text of United States of America and the State of New York ex rel. J. Doe v. Community Living Corporation (United States of America and the State of New York ex rel. J. Doe v. Community Living Corporation) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States of America and the State of New York ex rel. J. Doe v. Community Living Corporation, (S.D.N.Y. 2020).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK UNITED STATES OF AMERICA, and the STATE OF NEW YORK ex rel. MARIANNE T. O’TOOLE, as Trustee of the Bankruptcy Estate of Robert Douglas, Plaintiffs, 17 Civ. 4007 (KPF) -v.-

COMMUNITY LIVING CORPORATION; OPINION AND ORDER CREATIVE ESCAPES, LLC; DELORES LULGJURAY; JACK MUNGOVAN; DOUGLAS JURCZAK; CHRISTINE STILE; and JOHN PORCELLA, Defendants. KATHERINE POLK FAILLA, District Judge:

Plaintiff Marianne O’Toole, serving as Trustee for the Bankruptcy Estate of Relator Robert Douglas, brings this action on behalf of the United States and the State of New York against Defendants Community Living Corporation (“CLC”), Christine Stile, and John Porcella (together, the “CLC Defendants”), as well as Creative Escapes, LLC, Delores Lulgjuray, Jack Mungovan, and Douglas Jurczak. CLC bills for and receives reimbursements from Medicaid as part of its treatment of developmentally disabled individuals (“consumers”), and Plaintiff alleges that all Defendants participated in a variety of schemes to defraud Medicaid, in violation of the False Claims Act, 31 U.S.C. §§ 3729-3733 (the “FCA”), and the New York False Claims Act, N.Y. State Fin. Law §§ 187-194 (the “NYFCA”). Specifically, Plaintiff alleges that: (i) CLC’s management conspired with its employees to create Creative Escapes, LLC — a vacation company — and then induced CLC’s consumers to use Creative Escapes’s services; (ii) CLC

management made false statements to the New York State Office for People with Developmental Disabilities (“OPWDD”) by directing employees to sign documentation attesting that services were provided long after the services had actually been provided; (iii) CLC engaged in improper drug dispensing by failing to administer dosages or by providing drugs prescribed for one consumer to other consumers; (iv) CLC permitted consumers to engage in sexual relationships with one another despite the consumers lacking the mental capacity to properly consent; and (v) CLC failed to report issues of harm or

potential harm — known as “reportable incidents” — to OPWDD. Plaintiff also alleges that Relator was terminated in retaliation for his reporting of the above fraudulent schemes, in violation of the FCA and the NYFCA. The CLC Defendants have moved to dismiss this action under Federal Rule of Civil Procedure 12(b)(6). They argue, first, that Plaintiff should be judicially estopped from bringing her claims and, second, if judicial estoppel does not apply, that Plaintiff has nevertheless failed to state a claim upon which relief can be granted. For the reasons set forth in the remainder of this

Opinion, the CLC Defendants’ motion is granted in part and denied in part. BACKGROUND1 A. Factual Background 1. The Parties

Plaintiff is the Chapter 7 Trustee of the Bankruptcy Estate of Relator. (SAC ¶ 12). Relator was an employee of CLC from at least 2008 until December 14, 2014, the date of Relator’s termination. (Id. at ¶¶ 80, 92).2 Relator’s responsibilities included maintaining all records and documents relating to reportable incidents, serious reportable incidents, and allegations of abuse. (Id. at ¶ 80). Relator also had other responsibilities, including: (i) providing files, documents, and information for OPWDD surveys of CLC’s properties; (ii) overseeing fire safety; (iii) conducting site visits of CLC’s

properties and reporting findings from those visits; and (iv) conducting quality of life surveys with consumers. (Id. at ¶¶ 81-84). Creative Escapes, LLC is a limited liability company located in New York and owned and operated by Lulgjuray, Mungovan, and Jurczak. (SAC ¶ 16). All three individuals are also employees of CLC. (Id. at ¶¶ 17-19). Creative

1 The facts in this Opinion are drawn from Plaintiff’s Second Amended Complaint (“SAC” (Dkt. #50)), which is the operative pleading in this action. The Court also relies on the exhibits attached to the Declaration of Robert W. Sadowski (“Sadowski Decl., Ex. [ ]” (Dkt. #62)) and the exhibits attached to the Certification of Claudia A. Costa (“Costa Cert., Ex. [ ]” (Dkt. #65)). For ease of reference, the Court refers to the CLC Defendants’ opening brief as “Def. Br.” (Dkt. #58); to Plaintiff’s opposing brief as “Pl. Opp.” (Dkt. #61); and to the CLC Defendants’ reply brief as “Def. Reply” (Dkt. #64). 2 The SAC gives December 14, 2019, as the date of Relator’s termination. (SAC ¶ 92). Given the rest of the timeline laid out in the SAC, though, the Court assumes the actual year of Relator’s termination was 2014, and attributes the misdating to scrivener’s error. Escapes takes individuals with developmental disabilities, including CLC’s consumers, on vacations across the world. (Id. at ¶ 16). CLC is a non-profit agency created in 1991, with its principal office in

Mount Kisco, New York. (SAC ¶ 15). CLC is funded and licensed by the OPWDD, and it provides residential, vocational, and other services to consumers. (Id.). CLC operates 39 residential sites — known as Individual Residential Alternatives (“IRAs”) — each of which is separately licensed and regulated by OPWDD. (Id.). Plaintiff alleges that Stile and Porcella are either the owners, managers, or directors of CLC, and that Stile was Relator’s supervisor. (Id.). Relevantly for this action, CLC bills for and receives reimbursements

from Medicaid. (SAC ¶ 3). Medicaid is a joint federal-state program that provides healthcare benefits for eligible beneficiaries, which include the disabled. (Id. at ¶ 20). Each state that participates in Medicaid has its own agency that administers the program. (Id.). Enrollment in Medicaid carries certain requirements. In general, Medicaid will only reimburse for services that are medically necessary and appropriate, and it will not reimburse for services that are inappropriate, improper, unnecessary, excessive, inaccurately described, or that constitute unacceptable practices. (Id. at ¶¶ 35-36).

Moreover, New York regulations include compliance with all New York State Department of Health (“DOH”) regulations within the definition of acceptable practices. (Id. at ¶ 37). Further emphasizing the importance of following relevant regulations, an entity seeking to participate in Medicaid must fill out an enrollment form that requires the entity to certify that it will comply with DOH regulations. (Id. at ¶ 38). The enrollment form also requires that any claim for payment be true, accurate, and complete. (Id.).

CLC is further required to comply with New York regulations because it participates in the Home and Community-Based Services (“HCBS”) Waiver Program, which allows states to meet the needs of people who prefer to get long-term care services and support in their home or community, as opposed to an institutional setting. Home and Community-Based Services 1915(c), Medicaid.gov, https://www.medicaid.gov/medicaid/home-community-based- services/home-community-based-services-authorities/home-community- based-services-1915c/index.html. In New York, HCBS waiver services are

regulated by OPWDD. (SAC ¶ 29). To deliver HCBS waiver services, an entity must both complete an HCBS Provider Agreement and operate in accordance with specific provisions of the New York Codes, Rules and Regulations (the “NYCRR”). (Id. at ¶¶ 31-32). Plaintiff has highlighted several regulations that, she claims, are relevant to the issues in this action. (SAC ¶¶ 33, 39-40). These include: (i) regulations prohibiting the commercial exploitation of individuals; (ii) regulations protecting an individual’s right to express their sexuality as limited by their

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United States of America and the State of New York ex rel. J. Doe v. Community Living Corporation, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-of-america-and-the-state-of-new-york-ex-rel-j-doe-v-nysd-2020.