United States v. Nancy Smith

866 F.3d 1130, 2017 WL 3428096, 2017 U.S. App. LEXIS 14780
CourtCourt of Appeals for the Ninth Circuit
DecidedAugust 10, 2017
Docket16-10160
StatusPublished
Cited by5 cases

This text of 866 F.3d 1130 (United States v. Nancy Smith) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Nancy Smith, 866 F.3d 1130, 2017 WL 3428096, 2017 U.S. App. LEXIS 14780 (9th Cir. 2017).

Opinion

OPINION

THOMAS, Chief Judge:

In this appeal, we consider whether a criminal forfeiture action constitutes an “alternate remedy” to a civil qui tam action under the False Claims Act, entitling a relator to intervene in the criminal action and recover a share of the proceeds pursuant to 31 U.S.C. § 3730(c)(5). We hold that it does not, and we affirm the district court’s order denying intervention.

I

The criminal defendant, Neil Van Dyck, was a licensed podiatrist who owned and operated his own podiatry practice until October 2014. Relator Wendy Johnson worked as a medical assistant for Van Dyck from 1986 to 2008, and Relator Nancy Smith worked as a medical assistant and biller from 2006 to 2012.

A

In March 2011, Van Dyck’s unusual billings patterns for surgical nail avulsion, 1 skin graft, and ultrasound procedures prompted an investigation by SafeGuard Services, LLC (“SafeGuard”), a Medicare contractor ■ that investigates potential Medicare fraud and refers cases to law enforcement. In April 2011, SafeGuard notified Van Dyck of its investigation and requested that he submit medical records related to his treatment of eight Medicare beneficiaries between March 1, 2010, and February 28, 2011.

Van Dyck, submitted some of the requested records, but SafeGuard suspected that the records had been improperly created or altered. Based on its initial investigation, SafeGuard concluded that Van Dyck had committed Medicare 'fraud in violation of 18 U.S.C. § 24. It referred the matter to the U.S. Department of Health and Human Services Office of the Inspector General (“the Department”) in June 2011. SafeGuard continued to assist the Department with the investigation. -

SafeGuard sent Van Dyck a supplemental records request in November 2011 to account for the inconsistencies in Van Dyck’s initial record submission. Shortly thereafter, SafeGuard received a phone call from. Relator Smith—she identified herself at the time as “Nancy”—asking for more information on how to fulfill SafeGuard’s supplemental records request. Van Dyck submitted some of the requested supplemental records in January 2012. Again, the submitted records appeared to have been improperjy altered.

*1132 Shortly before receiving Van Dyck’s supplemental records, SafeGuard sent Medicare surveys to approximately forty-seven randomly selected Medicare patients whom Van Dyck treated. Twenty-three patients' responded to the survey. Although Van Dyck submitted Medicare claims for having performed surgical avulsions on eighteen of the twenty-three patients, the surveys revealed that those eighteen patients had received only routine foot care. Van Dyck began submitting claims for routine foot and nail care only after SafeGuard’s initial request for patient records.

On February 9, 2012, the Department received an anonymous complaint that Van Dyck billed Medicare for nail avulsions when his patients received only routine foot and nail care. The caller also stated that the employees performing the routine care were not licensed or trained to provide podiatry services. When those employees confronted Van Dyck about his billing practices, he told them to mind their own. business. The anonymous caller was later identified as Relator Smith.

On July 29, 2014, government investigators interviewed Relator Smith to. determine her role, if any, in Van Dyck’s submission of fraudulent claims. During the interview, Relator Smith explained that, after she sought clarification of the supplemental records request, she printed patient charts and other documents for Van Dyck. After Van Dyck reviewed and updated the documents, she reprinted them upon Van Dyck’s request. Relator Smith also confirmed that the computer system would only mark documents as “updated” if actual changes were made to the documents; merely printing would not trigger an update to the patient’s record. In addition, Relator Smith turned over to the government a work computer that Van Dyck gave her in 2006, when he updated the podiatry practice’s computer system. The government contends that the computer has little to no evidentiary value since it had not been used in Van Dyck’s podiatry practice or otherwise since 2006, before Van Dyck’s fraudulent conduct began.

Based on Safeguard's and the Department’s investigations, the government sought, under seal, a warrant to search Van Dyck’s office. During the execution of the search warrant, Van Dyck confessed to committing the fraud.

The government filed a criminal information on September 28, 2015, charging Van Dyck with one count of health care fraud in violation of 18 U.S.C. § 1347. Van Dyck pled guilty to the charge and agreed to forfeit funds from his retirement account as part of his plea agreement. On October 27, 2015, the district court issued a personal forfeiture money judgment against Van Dyck for $1.23 million, the estimated amount of fraudulent claims paid to Van Dyck by the victim insurers.

. B

On July 6, 2012, over a year after SafeGuard began its investigation of Van Dyck, Relators filed under seal a qui tam action against Van Dyck, pursuant to the False Claims Act, 31 U.S.C. § 3730(b). In their complaint, Relators alleged that, for ten years, Van Dyck submitted fraudulent claims to Medicare, Medicaid, and MediCal “for procedures not performed, for medical material not. used, for derma graphs used illegally ..., [and] for routine foot care not authorized for reimbursement .... ” Relators also alleged that Van Dyck falsified patient records to reflect procedures not performed, wrote chart notes to indicate that he saw patients he never saw, and billed as surgical procedures pedicures given to patients he never saw.

Relators’ qui tam action remained under seal until late January 2016, as a result of *1133 the government’s seven requests for six-month seal extensions for the purpose of conducting further investigations. See 31 U.S.C. § 3730(b)(3). However, the government did obtain a partial lift on the seal in November 2014 to disclose the qui tam action to Van Dyck. According to Relators’ attorney, one of the Assistant U.S. Attorneys handling the qui tam action told him that'Van Dyck’s defense attorney reported that “Van Dyck wants to resolve everything but recognizes there won’t be enough funds to cover all of the loss.” The U.S. Attorney’s Office proceeded to further investigate Relators’ qui tam claims over the next year and attempted to negotiate' a settlement agreement for the False Claims Act allegations in the qui tam suit. In November 2015, Van Dyck’s counsel informed the U.S. Attorney’s Office that Van Dyck rejected the government’s qui tam settlement offer and refused to continue settlement negotiations.

The government declined to intervene in the civil qui tam action on February 18, 2016.

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Cite This Page — Counsel Stack

Bluebook (online)
866 F.3d 1130, 2017 WL 3428096, 2017 U.S. App. LEXIS 14780, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-nancy-smith-ca9-2017.