US ex rel. Haile Nicholson v. Medcom Carolinas, Inc.

42 F.4th 185
CourtCourt of Appeals for the Fourth Circuit
DecidedJuly 21, 2022
Docket21-1290
StatusPublished
Cited by64 cases

This text of 42 F.4th 185 (US ex rel. Haile Nicholson v. Medcom Carolinas, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
US ex rel. Haile Nicholson v. Medcom Carolinas, Inc., 42 F.4th 185 (4th Cir. 2022).

Opinion

USCA4 Appeal: 21-1290 Doc: 30 Filed: 07/21/2022 Pg: 1 of 25

PUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 21-1290

UNITED STATES OF AMERICA EX REL. HAILE KIROS NICHOLSON,

Plaintiff - Appellant,

v.

MEDCOM CAROLINAS, INC.; JEFF TURPIN,

Defendants - Appellees,

and

JOHN DOES 1-50,

Defendants.

Appeal from the United States District Court for the Middle District of North Carolina at Greensboro. William L. Osteen, Jr., U.S. District Judge. (1:17-cv-00034-WO-LPA)

Argued: March 10, 2022 Decided: July 21, 2022

Before WYNN, HARRIS, and RICHARDSON, Circuit Judges.

Affirmed as modified by published opinion. Judge Richardson wrote the opinion, in which Judge Wynn and Judge Harris joined.

ARGUED: Volney LaRon Brand, BRAND LAW, PLLC, Dallas, Texas, for Appellant. Jeffrey Ryan Whitley, FOX ROTHSCHILD LLP, Raleigh, North Carolina, for Appellees. USCA4 Appeal: 21-1290 Doc: 30 Filed: 07/21/2022 Pg: 2 of 25

ON BRIEF: Stephen W. Petersen, FOX ROTHSCHILD LLP, Raleigh, North Carolina, for Appellees.

2 USCA4 Appeal: 21-1290 Doc: 30 Filed: 07/21/2022 Pg: 3 of 25

RICHARDSON, Circuit Judge:

While working for a company that makes skin grafts, Haile Kiros Nicholson caught

wind of a kickback scheme operating in a Veterans Administration hospital. In broad

strokes, the scheme involved the sale of skin grafts to the VA by commission-based

salespeople who were paid based on how much they sold. If true, that would likely violate

the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b, which would then make each

commission-induced sale a violation of the False Claims Act, 31 U.S.C. § 3729 et seq. So

Nicholson brought this qui tam suit as a False Claims Act relator on behalf of the United

States government and an analogous state-law claim under North Carolina law.

After the United States declined to intervene in the suit, Nicholson prosecuted it.

Because he used conclusory language in his original Complaint, the district court dismissed

the Complaint with prejudice for failure to state a fraud claim with particularity under

Federal Rule of Civil Procedure 9(b). When Nicholson moved to amend his Complaint

after judgment, the district court denied leave to amend, in part based on a finding of bad

faith.

We agree with the district court’s dismissal of the original Complaint for a lack of

particularity. Given that it is largely made up of conclusory allegations, the original

Complaint may even have failed Rule 8’s lower standard of plausibility. We also find that

the district court did not abuse its discretion in denying leave to amend for bad faith. So

we affirm the district court’s dismissal (with one minor modification, clarifying that a state-

law claim was dismissed without prejudice).

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I. Background

From what we can tell, the basic shape of Nicholson’s alleged kickback scheme is

simple enough. Integra made skin grafts, and they used another company, MedCom

Carolinas, Inc. (“MedCom Inc.”), to sell those skins grafts. MedCom Inc. is run by its

owner, Jeff Turpin. According to Nicholson, Turpin, and MedCom Inc. used independent

contractors to promote the Integra skin grafts and paid them by commission based on their

sales numbers. And paying commissions for referring the skin grafts to the VA would

violate the federal Anti-Kickback statute.

From there, the details get hazy fast. While litigating this case in the district court,

Nicholson offered two Complaints—his original Complaint and an Amended Complaint.

Because we need not reach the Amended Complaint, we focus on the original Complaint,

but include the allegations in the Amended Complaint to add some clarity to a confusing

set of allegations.

A. The Original Complaint

Nicholson filed his original Complaint under seal in 2017. It included five counts:

Counts I, II, and III were claims under three provisions of the False Claims Act, 31 U.S.C.

§§ 3729(a)(1)(A), (B) & (C); Count IV was a private cause of action under the Anti-

Kickback Statute, 42 U.S.C. § 1320a-7b; and Count V was under the North Carolina False

Claims Act, N.C. Gen. Stat. § 1-607.

In paragraph 16 of the Complaint, Nicholson describes the illegal scheme that

formed the basis of all his claims. Because much of the difficulty here comes from trying

4 USCA4 Appeal: 21-1290 Doc: 30 Filed: 07/21/2022 Pg: 5 of 25

to make heads or tails of what is being alleged in that paragraph, we include it here

verbatim:

Relator’s employer Integra utilized 1099 nonemployee reps to generate referrals for Medicare/Medicaid and other federal healthcare program patients in violation of the anti-kickback statute. Specifically, these representatives were paid by Jeff Turpin who owns MedCom LLC in whole or in part for furnishing items covered by federal healthcare programs and received commissions based on the same including PriMatrix and Integra Dermal Replacement Therapy. Relator learned of this scheme based upon his employment with Integra whereby these representatives engaged in national competitions with the full-time employees. Relator spoke with treating physicians, reimbursement personnel, and also received compensation for these 1099 nonemployee’s role in generating these sales. For example, on or about Nov 2016, Patient T. W. received an Integra Dermal Replacement Therapy graft furnished by Relator’s 1099 counterpart/sales representative Holloway whereby VA care benefits paid for this graft utilized by Dr. Phillips in excess of $3,000.00.

J.A. 15.

Some of the story comes through clearly enough: Nonemployee representatives—

in other words, independent contractors 1—were paid, at least in part by commission, to

furnish skin-graft products to federal healthcare programs like VA hospitals. That is the

basic kickback scheme. Representatives were paid commission to sell Integra skin grafts

to VA doctors. Nicholson learned about this scheme through his work at Integra and by

speaking to doctors and “reimbursement personnel.” Nicholson offers a sketch of one such

sale, from a salesperson called Holloway to a Dr. Phillips at a VA hospital, around

November 2016, for at least $3,000.

1 By “1099 nonemployee reps,” the Complaint is likely referring to the IRS form 1099-NEC, which is used to report income as an independent contractor. That form can be contrasted with the W2, which is the form used to report income as an employee. So we understand the reference to 1099 reps and the like to be lingo referring to workers who were independent contractors and not employees.

5 USCA4 Appeal: 21-1290 Doc: 30 Filed: 07/21/2022 Pg: 6 of 25

Though the outline is clear, there is considerable ambiguity and confusion about

the specifics. How Nicholson knows all this is obscure. “National competitions” are

mentioned—and competition does at least suggest promotion, incentives, and

inducements—but those competitions are not described in any detail at all. Nicholson says

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Cite This Page — Counsel Stack

Bluebook (online)
42 F.4th 185, Counsel Stack Legal Research, https://law.counselstack.com/opinion/us-ex-rel-haile-nicholson-v-medcom-carolinas-inc-ca4-2022.