United States of America v. Dental Health Programs Inc

CourtDistrict Court, N.D. Texas
DecidedJuly 29, 2021
Docket3:18-cv-00463
StatusUnknown

This text of United States of America v. Dental Health Programs Inc (United States of America v. Dental Health Programs Inc) is published on Counsel Stack Legal Research, covering District Court, N.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 of America v. Dental Health Programs Inc, (N.D. Tex. 2021).

Opinion

IN THE UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF TEXAS DALLAS DIVISION

UNITED STATES OF AMERICA and the § STATES OF TEXAS, ILLINOIS, § COLORADO and TENNESSEE ex rel. § DR. SUJATHA GOVINDARAJAN, § § Plaintiffs, § § v. § Civil Action No. 3:18-cv-00463-E § DENTAL HEALTH PROGRAMS, INC. d/b/a § COMMUNITY DENTAL CARE, et al., § § Defendants. §

MEMORANDUM OPINION AND ORDER

Before the Court is Defendants’ Motion to Dismiss the Corrected Third Amended Complaint for Failure to State a Claim (Doc. 108). Having carefully considered the motion, the parties’ briefing, the State of Texas’s Second Statement of Interest (Doc. 113), and applicable law, the Court concludes the motion should be GRANTED in part and DENIED in part. BACKGROUND The following allegations come from Relator Sujatha Govindarajan’s Corrected Third Amended Complaint (CTAC) (Doc. 107). Relator, a dentist, was employed by Defendant Dental Health Programs, Inc. d/b/a Community Dental Care (CDC) from 1999 to 2015. CDC, a non-profit dental service provider, received a majority of its funding from Medicaid and federal grants. In 2013, CDC discussed a possible affiliation with another non-profit dental service provider, Sarrell Regional Dental Center for Public Health, Inc. (Sarrell). Instead, both CDC and Sarrell became affiliated with DentaQuest Care Group (DQCG), a non-profit subsidiary of 1 Defendant Dental Service of Massachusetts d/b/a Delta Dental of Massachusetts (DSM), “the ultimate parent of all DQ entities.” According to Relator’s complaint, Sarrell employees Jeff Parker (CEO), Chris Haugen

(General Counsel), and Jeremy Slayton (CFO) then took over control and operations of CDC. Parker served as Chairman of the CDC Board of Directors; Haugen served as the Board’s Secretary and also VP of Business Development. According to the CTAC, Parker, Haugen, and Slayton also were employees of Defendant DentaQuest, LLC (DQ LLC), a for-profit dental benefits administrator, and, thereafter, CDC hired DQ LLC to provide administrative and management services. During this transition, Relator served as CDC’s Dental Director. She was moved to a

general dentist position on August 14, 2014, about a week after raising “several violations and non-compliance of Federal Grants terms and conditions.” She later learned of “additional Medicaid and Federal Grants fraud in the form of upcoding of non-surgical extractions, billing of uncredentialed dentists under credentialed dentists, overtreatment, and non-compliance with Federal Grant terms and conditions, falsely certifying them at the time of renewal.” On May 1, 2015, Relator complained through counsel to CDC regarding employment

issues, Medicaid and federal grant fraud, and forgery on Relator’s MCNA Medicaid Contract, which Relator refused to sign because CDC was not compliant with the contract’s terms. CDC offered to mediate. After Relator complained that the issues she raised were not being addressed, Tom Bixby, a compliance counsel hired by DQ LLC, contacted her to investigate the CDC compliance issues.

2 On August 21, 2015, Relator received an email from Ron Price, CDC Compliance Officer, asking to discuss CDC compliance issues. Relator later learned Price was a DQ LLC attorney and also a compliance officer for Defendant DentaQuest USA Insurance Company (DQ

USA), a DQ LLC subsidiary that procured Medicaid contracts in Texas, Colorado, and Tennessee. Also in August 2015, DQ LLC, “representing itself to be the Texas Medicaid administrator,” sent Relator a chart audit letter asking her to send her patient records to DentaQuest, Inc. a/k/a DentaQuest Group Inc. (DQ Inc.), DQ LLC’s parent company. Based on these events, Relator became aware “CDC was covertly controlled and operated by DQ LLC” and suspicious whether DQ LLC was disclosed as a controlling entity to CDC’s federal grant funders. Relator requested a copy of her provider contracts and learned that she

had signed her September 30, 2011 provider service agreement with DQ USA. As a result, she became suspicious as to which entity had contracted with the Texas Health and Human Services Commission (HHSC) for the Texas Medicaid Contract and whether HHSC was aware that DQ LLC was performing obligations under the contract. On November 5, 2015, Relator emailed CDC Executive Director Kevin Sutton to investigate her contracts further and invoked section 36.115 of the Texas Medicaid Fraud

Prevention Act (TMFPA). See TEX. HUM. RES. CODE ANN. § 36.001 et seq. Her email access to CDC was “shut off” the next day and, on November 7, 2015, she received a termination letter from CDC. After her termination, Relator confirmed her suspicion that DQ LLC “was the administrator to [the] Texas Medicaid Contract, without being a party to the contract.” DQ LLC also provided services for the Colorado and Tennessee Medicaid Contracts without being

3 disclosed as a party to the contracts. Further, DQ LLC did not hold licenses from the State of Texas, Colorado, or Tennessee departments of insurance. Relator has amended her complaint three times.1 In five counts, the CTAC asserts

violations of the False Claims Act (FCA), 36 U.S.C. § 3729 et seq., the TMFPA, the Colorado Medicaid False Claims Act (CMFCA), COLO. REV. STAT. § 25.5-4-303.5 et seq.; and the Tennessee Medicaid False Claims Act (TMFCA), TENN. CODE ANN. § 71-5-181 et seq. Relator alleges Defendants are liable for “(a) submission of false and fraudulent claims to the federal government and States of Colorado and Tennessee, (b) committing Unlawful Acts and overinflating expenses in Texas, and (d) [sic] making false statements to the funders of Federal Grants after the grants were awarded” (Doc. 107, p. 9). Relator also asserts retaliation claims.

Defendants move to dismiss all of the claims against them under Federal Rule of Civil Procedure 12(b)(6). LEGAL STANDARD

Federal Rule of Civil Procedure 8(a)(2) provides that a complaint must contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). A complaint alleging fraud also must satisfy the heightened pleading standard of Federal Rule of Civil Procedure 9(b). Fed. R. Civ. P. 9(b); see United States ex rel. Grubbs v. Kanneganti, 565 F.3d 180, 185 (5th Cir. 2009) (applying Rule 9(b) to FCA claims); United States ex rel. Foster v. BristolMyers Squibb Co., 587 F. Supp.2d 805, 827 (E.D. Tex. 2008) (applying Rule 9(b) to TMFPA and other state FCA claims).

1 On a previous motion (Doc. 47), the Court dismissed Relator’s claims except her claims for retaliation with respect to those retaliatory acts alleged after February 26, 2015 against CDC. The Court dismissed Relator’s state law fraudulent inducement claims with prejudice. The Court granted leave for Relator to amend her complaint to replead the remaining claims (Doc. 92). 4 Rule 12(b)(6) authorizes a court to dismiss a plaintiff’s complaint for “failure to state a claim upon which relief can be granted.” FED. R. CIV. P. 12(b)(6). In considering a Rule 12(b)(6) motion to dismiss, “[t]he court accepts all well-pleaded facts as true, viewing them in

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