United States Ex Rel. Davis v. District of Columbia
34 F. Supp. 3d 30
D.D.C.2014Background
- Davis, a qui tam relator and former contractor for DCPS Medicaid cost reports, alleges the District submitted FY1998 Medicaid reimbursement claims without required audit-quality supporting documentation, violating the False Claims Act (FCA).
- DCPS submitted Maximus-prepared reports (a medical Cost Report and a Transportation Report) to the District Medicaid agency (MAA), which obtains federal reimbursement from CMS; interim payments were later reconciled by year-end cost settlement reports.
- An independent auditor (Bert Smith) found inadequate documentation and concluded the District should return ~$7.6 million of a $10.3 million FY1998 settlement; that amount was returned.
- Procedurally: District court previously dismissed for lack of jurisdiction under Findley but D.C. Circuit reversed, holding Davis an "original source"; damages remained zero because services were provided, but civil penalties remained possible.
- On summary judgment the court held the Maximus Cost Report claim is time-barred (presented Jan. 12, 2000) but granted Davis summary judgment as to liability for the Maximus Transportation Report under an implied-false-certification theory.
- Because the government received the services, it suffered no compensatory damages; the court imposed a single civil penalty of $11,000 and awarded Davis 30% of that recovery.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether claims based on the Maximus Cost Report are time-barred | Davis disputed the submission date; contended material fact exists | District produced a MAA "RECEIVED" stamp showing Jan. 12, 2000; statute of limitations bars claims before Apr. 4, 2000 | Maximus Cost Report claims are barred by the 6-year statute of limitations (submitted Jan.12,2000) |
| Whether submission of reports to MAA constitutes presentment to federal government under the FCA | Davis: submission to MAA qualifies because federal government funds majority of Medicaid payments | District previously contested presentment to federal government but conceded in this round | Submission to MAA satisfies FCA presentment requirement because federal funds (FFP) reimburse MAA |
| Whether the Transportation Report was a "false" claim via implied false certification (lack of required documentation) | Davis: District lacked physical possession of required audit-quality records when submitting report; that noncompliance was material | District: argued constructive possession via Davis or that required documentation was available; challenged materiality | Court held Transportation Report was implicitly false: District lacked required documentation, material to reimbursement; implied agency/constructive-possession theory failed |
| Whether the District acted "knowingly" under the FCA | Davis: warned District officials repeatedly that only he had documentation; submission despite warnings shows at least reckless disregard | District: claimed reliance on Davis to provide documents or at most negligence | Court found the District acted knowingly (actual knowledge or reckless disregard); summary judgment for Davis on liability for Transportation Report |
Key Cases Cited
- Rockwell Int'l Corp. v. United States, 549 U.S. 457 (Sup. Ct. 2007) (clarified scope of original-source/jurisdictional analysis under FCA)
- United States ex rel. Davis v. District of Columbia, 679 F.3d 832 (D.C. Cir. 2012) (D.C. Cir. held Davis an original source and that government suffered no damages though penalties remain available)
- Science Applications Int'l Corp. v. [case name], 626 F.3d 1257 (D.C. Cir. 2010) (explains implied false certification and materiality in FCA claims)
- Siewick v. Jamieson Sci. & Eng'g, 214 F.3d 1372 (D.C. Cir. 2000) (discusses when claims lacking required documentation can be implicitly false)
- Findley v. FPC-Boron Employees' Club, 105 F.3d 675 (D.C. Cir. 1997) (prior D.C. Circuit original-source precedent discussed and distinguished)
- Celotex Corp. v. Catrett, 477 U.S. 317 (Sup. Ct. 1986) (summary judgment standards)
- Anderson v. Liberty Lobby, 477 U.S. 242 (Sup. Ct. 1986) (summary judgment standards on genuine dispute of material fact)
- United States v. Bornstein, 423 U.S. 303 (Sup. Ct. 1976) (discusses counting of fraudulent acts/claims for FCA purposes)