United States v. Coloplast Corp.

327 F. Supp. 3d 300
District Court, District of Columbia·Decided August 17, 2018·No. CIVIL ACTION NO. 11-12131-RWZ·Published·Cited by 2 cases

Opinion

RYA W. ZOBEL, SENIOR UNITED STATES DISTRICT JUDGE

*302Plaintiffs Kimberly Herman, Amy Lestage, and Kevin Roseff are current and former employees of a durable medical equipment manufacturer called Coloplast Corp. They bring this case as qui tam relators and allege in Counts IV, V, VI, and VII of their Third Amended Complaint that defendant Shield California Health Care Center, Inc. ("Shield"), conspired to and did submit improper reimbursement bills to the State of California in violation of the False Claims Act, 31 U.S.C. § 3729(a), and California's analogous state statute, Cal. Gov't Code §§ 12651(a).

Defendant has moved for summary judgment (Docket # 301) and to strike and exclude certain declarations and arguments submitted by plaintiffs in opposition thereto (Docket # 317).

I. Factual Background

Defendant provides medical equipment to beneficiaries of California's Medicare program (called "Medi-Cal") and then seeks reimbursement from that state and federally-funded initiative. This case centers on allegations that defendant's reimbursement claims overcharged the government1 by means of an invoicing arrangement devised to circumvent Medi-Cal's billing regulations. Set forth below are the relevant facts which, when disputed, I view in the light most favorable to plaintiffs as the party opposing summary judgment. See O'Connor v. Steeves, 994 F.2d 905, 907 (1st Cir. 1993).

A. Medi-Cal's Upper Billing Limit Regulation

The California Department of Health Care Services (the "Department") administers Medi-Cal. In 2003, it filed an emergency regulation called the Upper Billing Limit ("UBL") to address "abusive billing conduct," including "the practice of obtaining steep discounts (whether legitimate or not) and then turning around and billing Medi-Cal at maximum reimbursement rates." See California Ass'n of Med. Prod. Suppliers v. Maxwell-Jolly, 199 Cal.App.4th 286, 131 Cal.Rptr.3d 692, 714 (2011) (upholding UBL against challenge brought by trade association (of which defendant in this case is a member) ). In *303passing the UBL, the Department sought to close a "loophole in state law that did not effectively link reimbursement to the provider's purchase cost." Id. at 704 (quoting rulemaking record). In relevant part, the regulation achieves its purposes by limiting claims for reimbursement to a 100% markup of provider's "net purchase price" for an item. "Net purchase price" is "defined as the actual cost to the provider to purchase the item, including any rebates, refunds, discounts or any other price reducing allowances, known by the provider at the time of billing the Medi-Cal program for the item, that reduces the item's invoice amount." Cal. Code Regs., tit. 22, § 51008.1(a)(2)(A). The UBL also requires that "[t]he net purchase price shall reflect price reductions guaranteed by any contract to be applied to the item(s) billed to the Medi-Cal program." Cal. Code Regs. tit. 22, § 51008.1(a)(2)(B). According to the UBL's Initial Statement of Reasons, " 'net purchase price' is understood by the regulated community to be the amount actually paid for an item after all discounts or rebates have been taken." See Docket # 311-2 at 7.

"The [UBL] generated considerable public comment and opposition" when it was promulgated, "including comments by [defendant] and the trade association of which [defendant] is a member." Docket # 309 ¶ 3. How rebates and discounts should be treated for "net purchase price" calculations was among the topics discussed. For example, in response to an industry request that the UBL be amended to explicitly exclude "growth or volume discounts" from a product's net purchase price, the Department declined to change the rule and instead responded that the UBL "already excludes after the fact discounts." Docket # 309 ¶ 6. In response to other comments, Medi-Cal also clarified that "net purchase price includes rebates, discounts, credits and other price-reducing adjustments known to the providers at the time they bill for the item." Id. at Response to ¶ 6.

B. The Shield-Coloplast Scheme

In 2010, defendant's supplier agreement with medical supply manufacturer Coloplast was expiring and the two companies negotiated a new contract. The agreement set forth the price of Coloplast's products in a series of tables attached to the contract. It also provided that, when Shield purchased enough products in a given three-month quarter, it would receive rebates to be paid by check no later than 60 days after the quarter's end. The rebates were structured into four tiers; the highest rebate ("Tier 4" for "Category A" products) equaled a 66% discount.

Plaintiff Herman, then President of U.S. Coloplast, and plaintiff Roseff, then Coloplast's Director of Distribution, were involved in the contract negotiation process. According to Roseff, the 2010 Shield-Coloplast agreement was "different" and "unusual." Docket # 311-4 at 6. The prices Coloplast was offering to Shield were "substantially higher than [for] any other customer," id. at 12-13, as were the "substantial discounts and rebates", id. at 6.2 Mr. *304Roseff "had never seen a contract that had this type of incentive schedule attached to it," and the "double digit" rebates "jumped out" to him given their relationship to the high invoice prices.

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United States v. Coloplast Corp., 327 F. Supp. 3d 300 (D.D.C. 2018).

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