VIB Partners v. LHC Group, Inc.

CourtDistrict Court, D. Maryland
DecidedNovember 1, 2022
Docket1:21-cv-02232
StatusUnknown

This text of VIB Partners v. LHC Group, Inc. (VIB Partners v. LHC Group, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
VIB Partners v. LHC Group, Inc., (D. Md. 2022).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND

UNITED STATES OF AMERICA * ex rel. VIB PARTNERS, et al., * Plaintiffs, * v. * Civil Action No. RDB-21-2232 LHC GROUP, INC., * Defendants. *

* * * * * * * * * * * * *

MEMORANDUM ORDER Relators VIB Partners, John Estabrook, and Leann Marshall filed this qui tam action on behalf of the United States under the False Claims Act (“FCA”), 31 U.S.C. §§ 3729 et seq.1 Through the operative qui tam Complaint, Relators contend that Defendant LHC Group, Inc. (“LHC”) defrauded the United States Government by falsifying patient data on the Medicare Outcome and Assessment Information Set (“OASIS”) system to collect inflated Medicare reimbursements. (Compl. ¶¶ 3–4, ECF No. 1.) Now pending is Defendant LHC Group’s Motion to Dismiss or to Transfer in the Alternative (ECF No. 17). The parties’ submissions have been reviewed and no hearing is necessary. See Local Rule 105.6 (D. Md. 2021). For the reasons set forth below, Defendant’s Motion is construed as a motion to transfer and is

1 As Judge Hollander of this Court has noted, the False Claims Act and Maryland False Claims Act “allow a private party, as relator, to sue on behalf of the government to recover damages against defendants who have caused fraudulent claims for payment to be submitted against the public fisc. As an incentive to bring such suits, a successful relator is entitled to share in the government's recovery from the defendants.” U.S. ex rel. Palmieri v. Alpharma, Inc., 928 F. Supp. 2d 840, 842 (D. Md. 2013). GRANTED. This case is hereby TRANSFERRED to the United States District Court for the Eastern District of Tennessee. BACKGROUND

A court ruling on a motion to dismiss or a motion to transfer “accept[s] as true all well- pleaded facts in a complaint and construe[s] them in the light most favorable to the plaintiff.” Wikimedia Found. v. Nat’l Sec. Agency, 857 F.3d 193, 208 (4th Cir. 2017) (citing SD3, LLC v. Black & Decker (U.S.) Inc., 801 F.3d 412, 422 (4th Cir. 2015)); see also Cosmopolitan Inc. v. PNC Bank, Nat’l Ass’n, No. GLR-19-2744, 2020 WL 4287439, *3 (D. Md. July 27, 2020) (motions to transfer). The following facts are derived from Relators’ qui tam Complaint and accepted as

true for the purpose of Defendant’s motion. Defendant LHC Group, Inc. (“LHC”) “is a provider of home health and hospice services that primarily services elderly patients, the majority of whom are beneficiaries of Government health insurance programs.” (Compl. ¶ 17, ECF No. 1.) Home health services are a cost-effective alternative to traditional inpatient care, and a guaranteed Medicare benefit for patients who are certified as homebound. 42 U.S.C. § 1395f(a). (Compl. ¶¶ 30–34, 45 n.4.)

Accordingly, agencies such as LHC Group may obtain reimbursement through Medicare for home health services they provide. (Compl. ¶¶ 34, 38.) Medicare reimburses home health services at a fixed rate for each incremental sixty-day period of care provided to each patient. (Id. ¶ 44.) This rate is calculated based on the patient’s health conditions, clinical characteristics, and service needs, as documented in the OASIS system. (Id. ¶¶ 39–43.) Relators Leann Marshall, VIB Partners, and John Estabrook2 collectively allege that “LHC implements a corporate-wide scheme in which it directs its facilities to systematically falsify the coding and assessment of patient’s health conditions, and the number of therapy

and nursing visits provided to patients,” thereby submitting false claims to Medicare and inflating its Medicare reimbursements. (Id. ¶¶ 3, 109–60, 256–57.) Among other allegations, Relators claim that LHC adjusts patients’ symptoms to satisfy the Medicare definition of “homebound,” changes the nature of the healthcare services provided to eligible patients, and increases the number of recorded visits to each patient without regard to whether those visits are medically necessary—all in an effort to wrongfully inflate its Medicare reimbursements.

(Id. ¶¶ 101, 166, 193, 239.) Relators contend that LHC accomplishes these changes by directing clinicians, coders, and low-level employees to change their OASIS entries, informing its facility managers and directors to “override” clinicians’ OASIS assessments, and using a software program to “scrub” OASIS data. (Id. ¶¶ 101–04, 109, 112–16, 123–30.)3

2 Relator Leann Marshall is a registered nurse who was employed as a clinician and team leader at the University of Tennessee Medical Center Home Care Services, LLC, a facility owned and operated by Defendant, until her termination on June 2, 2016. (Id. ¶ 16.) Relator John Estabrook was employed as the Divisional Vice President of Operations for LHC, and managed LHC operations in Washington, D.C., West Virginia, and Ohio. (Id. ¶ 15.) Relator VIB Partners is a partnership between two LHC corporate officials, including Estabrook. (Id. ¶¶ 14–15, 23.) According to the Complaint, both partners “managed multiple locations for LHC over time and in different geographies,” and were responsible for reviewing “retrospective reports regarding OASIS scoring of Medicare patients and claims submitted over time.” (Id. ¶¶ 23–25.) Relators claim that this broad scope gave VIB Partners “personal knowledge concerning LHC’s knowledge of the fraudulent conduct, and the nationwide scope of LHC’s fraudulent practices.” (Id. ¶ 24.) 3 Relators further allege that LHC was aware of the impropriety of these changes since at least 2011, when internal audits reflected that improper OASIS entries had been submitted to Medicare. (Id. ¶¶ 130–34.) In 2017, LHC conducted approximately 72,000 management overrides in its Beltway division despite its managers acknowledging that these overrides “look[ed] like fraud.” (Id. ¶¶ 134, 136–40.) In 2019, LHC may have conducted as many as 63,000 overrides nationally. (Id. ¶ 143.) Collectively, Relators allege that these practices resulted “in large volumes of inflated claims paid by Medicare.” (Id. ¶ 233.) This is not Relators’ first attempt to bring a qui tam action against LHC for this alleged scheme. In 2017, Marshall and VIB filed separate FCA complaints against LHC in Tennessee: Marshall filed in the United States District Court for the Western District of Tennessee, while

VIB filed in the United States District Court for the Eastern District of Tennessee. See United States ex rel. Marshall v. Univ. of TN Med. Ctr. Home Care Servs., LLC, No. 3:17-CV-96, 2021 WL 3743189, at *4 (E.D. Tenn. Aug. 23, 2021). When the United States declined to intervene, Marshall’s case was transferred to the Eastern District of Tennessee and consolidated with VIB’s action on July 17, 2020. Id. Thereafter, Relators filed their Consolidated Amended Complaint. Id. Through their Consolidated Amended Complaint, Relators claimed that LHC

was submitting inflated Medicare claims through the same “corporate-wide” OASIS override scheme at issue in this case. (Consolidated Amd. Compl. (“CAC”) ¶¶ 3–8; ECF No. 24-5.) Relators further alleged that Marshall was improperly terminated by UTMC after reporting LHC’s unlawful conduct. (Id. ¶ 9.) LHC moved to dismiss the case, and on August 23, 2021, the United States District Court for the Eastern District of Tennessee granted this motion in part, concluding that the

filing of United States ex rel. Bowling v. LHC Group, Inc., No. 6:14-cv-94 (E.D. Ky. Apr.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Gulf Oil Corp. v. Gilbert
330 U.S. 501 (Supreme Court, 1947)
Van Dusen v. Barrack
376 U.S. 612 (Supreme Court, 1964)
Piper Aircraft Co. v. Reyno
454 U.S. 235 (Supreme Court, 1982)
Stewart Organization, Inc. v. Ricoh Corp.
487 U.S. 22 (Supreme Court, 1988)
C.R.A. Realty Corp. v. Enron Corp.
842 F. Supp. 88 (S.D. New York, 1994)
Mamani v. Bustamante
547 F. Supp. 2d 465 (D. Maryland, 2008)
Cross v. Fleet Reserve Ass'n Pension Plan
383 F. Supp. 2d 852 (D. Maryland, 2005)
Samsung Electronics Co., Ltd. v. Rambus, Inc.
386 F. Supp. 2d 708 (E.D. Virginia, 2005)
Stratagene v. Parsons Behle & Latimer
315 F. Supp. 2d 765 (D. Maryland, 2004)
D2L LTD. v. Blackboard, Inc.
671 F. Supp. 2d 768 (D. Maryland, 2009)
Byerson v. Equifax Information Services, LLC
467 F. Supp. 2d 627 (E.D. Virginia, 2006)
Lynch v. Vanderhoef Builders
237 F. Supp. 2d 615 (D. Maryland, 2002)
Cronos Containers, Ltd. v. Amazon Lines, Ltd.
121 F. Supp. 2d 461 (D. Maryland, 2000)
Nutrition & Fitness, Inc. v. Blue Stuff, Inc.
264 F. Supp. 2d 357 (W.D. North Carolina, 2003)
SD3, LLC v. Black & Decker (U.S.) Inc.
801 F.3d 412 (Fourth Circuit, 2015)
Wikimedia Foundation v. National Security Agency
857 F.3d 193 (Fourth Circuit, 2017)
United States ex rel. Salomon v. Wolff
268 F. Supp. 3d 770 (D. Maryland, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
VIB Partners v. LHC Group, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/vib-partners-v-lhc-group-inc-mdd-2022.