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Keywords

lawsuitplaintiffdefendantpleamotioncivil proceduremotion to dismiss
plaintiffdefendantpleamotioncivil proceduremotion to dismiss

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United States ex rel. Emerson Park v. Legacy Heart Care, LLC, Not Reported in Fed. Supp., 2019 WL 4450371, Med & Med GD (CCH) P 306,613

Facts

Emerson Park, a former employee of Legacy Heart Care (LHC), filed a qui tam lawsuit alleging that LHC and its medical directors submitted false claims to Medicare for EECP services that did not meet the necessary diagnostic criteria. The relator claimed that the defendants engaged in a pattern of fraudulent conduct, including upcoding services and paying kickbacks to patients. This was Park's fourth attempt to state a claim, following previous dismissals for insufficient pleading.

On his fourth attempt to state a claim, Relator—a former scribe employed by LHC for approximately seven months—continues to claim that LHC Defendants and Medical Director Defendants “engaged in a pervasive pattern of false and fraudulent conduct with respect to its provision of EECP and related services to Medicare patients.”

Issue

Did the relator sufficiently plead claims against the defendants under the False Claims Act, and were the motions to dismiss properly granted?

Did the relator sufficiently plead claims against the defendants under the False Claims Act, and were the motions to dismiss properly granted?

Rule

To survive a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), a plaintiff must plead enough facts to state a claim that is plausible on its face. Additionally, allegations of fraud must meet the heightened pleading standard of Rule 9(b), requiring specificity regarding the circumstances constituting fraud.

To survive a motion to dismiss filed pursuant to Federal Rule of Civil Procedure 12(b)(6), a plaintiff must plead “enough facts to state a claim to relief that is plausible on its face.”

Analysis

The court analyzed whether the relator's allegations met the standards set forth in the False Claims Act and the relevant procedural rules. It found that while some claims were sufficiently pleaded, others were not, particularly those against certain defendants who were not adequately linked to the alleged fraudulent conduct. The court emphasized the need for specific factual allegations rather than generalized accusations.

The court analyzed whether the relator's allegations met the standards set forth in the False Claims Act and the relevant procedural rules. It found that while some claims were sufficiently pleaded, others were not, particularly those against certain defendants who were not adequately linked to the alleged fraudulent conduct.

Conclusion

The court granted the motions to dismiss for certain defendants with prejudice, concluding that the relator failed to provide sufficient factual support for the claims against them. However, it allowed some claims to proceed, indicating that the relator had met the pleading requirements for those specific allegations.

The court granted the Motions to Dismiss as to every Count alleged against Michael Gratch, Vu D. Nguyen, Trinity Heart Care, LHC of San Antonio, and LHC of Kansas City with prejudice.

Who won?

The LHC Defendants and Medical Director Defendants prevailed in part, as the court dismissed several claims against them with prejudice due to insufficient pleading.

The Court finds that Relator's allegations against Michael Gratch, Vu D. Nguyen, Trinity Heart Care, LHC of San Antonio, and LHC of Kansas City are so deficient that they may, again, rise to the level of a Federal Rule of Civil Procedure 11(b) violation.

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