United States v. Pathway of Baldwin County, LLC

District Court, S.D. Alabama·Decided October 10, 2024·No. 1:17-cv-00355·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF ALABAMA SOUTHERN DIVISION

UNITED STATES OF AMERICA, ) ex rel RICHARD J. SHEPPARD, ) ) Plaintiff, ) ) vs. ) CIVIL ACTION NO. 17-00355-KD-N ) PATHWAY OF BALDWIN COUNTY, ) LLC and PATHWAY, INC., ) ) Defendants. )

ORDER

This action is before the Court on Defendants Pathway of Baldwin County LLC (PBC) and Pathway, Inc.’s Renewed Motion for Judgment as a Matter of Law, or in the alternative, Motion for New Trial (doc. 162). Upon consideration, and for the reasons set forth herein, the Motion is DENIED. A. Renewed Motion for Judgment as a Matter of Law “Judgment as a matter of law is appropriate only if ‘a reasonable jury would not have a legally sufficient evidentiary basis to find for the’” non-moving party. Action Nissan, Inc. v. Hyundai Motor Am., No. 22-13153, 2024 WL 3888756, at *5 (11th Cir. Aug. 21, 2024) (citing Fed. R. Civ. P. 50(a)). “‘Only the sufficiency of the evidence matters; what the jury actually found is irrelevant.’” Id. (quoting Hubbard v. BankAtlantic Bancorp, Inc., 688 F.3d 713, 724 (11th Cir. 2012)). The court must “view[] the evidence in the light most favorable to the non- moving party.” Id. (quoting Howard v. Walgreen Co., 605 F. 3d 1239, 1242 (11th Cir. 2010)). Overall, “[j]udgment as a matter of law is appropriate only if the facts and inferences point overwhelmingly in favor of one party, such that reasonable people could not arrive at a contrary verdict.” Luxottica Grp., S.p.A. v. Airport Mini Mall, LLC, 932 F.3d 1303, 1310 (11th Cir. 2019). Thus, the court should not “disturb a jury's verdict unless ‘there is no legally sufficient evidentiary basis for a reasonable jury to find’ for the party on that issue.” Action Nissan, Inc., 2024 WL 3888756, at *5 (quoting Lipphardt v. Durango Steakhouse of Brandon, Inc., 267 F.3d 1183, 1186 (11th Cir. 2001) (internal quotation marks and citation omitted)). Also, a “Rule 50(b) motion is merely a renewal of a previously asserted motion brought under Rule 50(a), and ‘thus a district court can grant a Rule 50(b) motion “only on grounds advanced in the preverdict Rule 50(a) motion.” ’ ” Id. (quoting McGinnis v. Am. Home Mortg. Servicing, Inc., 817 F.3d

1241, 1260 (11th Cir. 2016) (alterations adopted) (quoting Fed. R. Civ. P. 50 advisory committee's note to 2006 amendment)). 1. Sufficiency of the evidence as to retaliation The False Claims Act identifies two types of protected activity: “lawful acts done … in furtherance of an action under” the FCA or “other efforts to stop” violations of the FCA. 31 U.S.C. § 3730(h)(1). Defendants argue that Sheppard, “… ‘who argues that [his] conduct was in the form of ‘other efforts” to stop a FCA violation must at least show that [he] had an objectively reasonable belief that [his] employer violated the FCA to establish that [he] engaged in protected activity.’” (doc. 162, p. 2). Defendants assert that belief that the employer committed legal or ethical violations, or fraud, or misuse of federal funds is not sufficient because the employee

must reasonably believe that the employer has submitted a false or fraudulent claim to the federal government (Id.). Defendants argue that the evidence Sheppard submitted at trial was not sufficient for a reasonable jury to find that he had an objectively reasonable belief that PBC had made false claims for payment with the Alabama Medicaid Agency based upon false or fraudulent Basic Living Skills (BLS) sheets (Id., p. 4). Defendants argue that Sheppard’s trial testimony established only that he knew that BLS sheets were placed in a box in the PBC office, that he had no evidence or knowledge of the process thereafter, and consequently no evidence “of any BLS sheets or any other document that was fraudulent that was submitted by PBC to Medicaid for payment” (Id., p. 4-5, citing doc. 159, p. 52-59). Defendants point out that Sheppard admitted that PBC had a review process that would find mistakes in BLS sheets and that completing a BLS sheet is only the initial step in the process of making a claim for payment with Medicaid, and therefore “the fact that a BLS sheet is found to be inaccurate, false, or otherwise non-compliant with Medicaid regulations is not

evidence that a false claim was ever submitted to Medicaid for payment” (Id., p. 5). As a result, Defendants argue that Sheppard did not have “an objectively reasonable belief that PBC ultimately submitted false claims for payment.” (Id.). Defendants also argue that Sheppard’s testimony regarding statements by other employees regarding corrections to BLS sheets does not support a finding that he had an objectively reasonable belief that false claims were actually submitted to Medicaid. Instead, they argue that the evidence indicates that his belief or assumption was speculative and he had no evidence, but for his allegations of corrections, falsifications, or additions to BLS sheets which were based on the employee statements. Viewing the evidence in the light most favorable to Sheppard, the Court finds that the

evidence was sufficient for a jury to find that Sheppard had an objectively reasonable belief that false claims were submitted to Medicaid. Albeit that Sheppard admitted a lack of knowledge as to the entire Medicaid billing process, he presented evidence that BLS sheets were a primary and important starting point and that employees were allowed or encouraged to correct or amend BLS sheets in a manner that caused him to believe that false claims were submitted. The facts and inferences do not point overwhelmingly in favor of the Defendants such that a reasonable jury could not decide in favor of Sheppard on this issue. 2. Defendants’ awareness of protected activity Defendants argue that “Sheppard failed to present sufficient evidence for a reasonable jury to find that Pathway was aware of any protected activity by Sheppard” and therefore, he cannot establish a causal connection between his protected activity and the adverse employment actions (doc. 162, p. 8-11). Defendants point out that Sheppard admitted at trial that he “expressed his concerns” with a Targeted Case Manager (TCM), but when questioned by

Defendants’ employees, Sheppard repeatedly denied any knowledge of or concerns with Medicaid fraud. Defendants point out that all employees testified at trial that no one had complained “regarding allegations of padding time, forging signature, or making up details on BLS document” (Id.). The Court disagrees that the evidence was insufficient to establish Defendants’ awareness of Sheppard’s protected activity. Specifically, there was evidence that the Executive Director of Pathway of Baldwin County LLC, Kimberly Fail, specifically questioned Sheppard regarding his allegations of Medicaid fraud made to a TCM. Sheppard testified at trial that he talked with a TCM, a case manager for the State of Alabama, about the possible falsification of documents for submission to Medicaid (doc. 159, p.

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United States v. Pathway of Baldwin County, LLC, (S.D. Ala. 2024).

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