United States v. Dynamic Visions, Inc.
216 F. Supp. 3d 1
| D.D.C. | 2016Background
- Dynamic Visions, a D.C. home‑health provider owned and run by Isaiah Bongam, submitted Medicaid reimbursement claims from Jan. 2006–June 2009.
- D.C. Medicaid regulations and Dynamic Visions’ provider agreement require written, physician‑approved plans of care authorizing services; DHCF will not pay unauthorized services.
- Post‑payment review by DHCF, then investigations by FBI and HHS‑OIG, found many patient files lacking plans of care, unsigned/backdated plans, or plans that did not authorize billed services; numerous records and invoices were seized.
- Plaintiff (U.S.) sued under the False Claims Act (FCA) for false claims, false certifications/false records, and common‑law fraud; Plaintiff moved for summary judgment against Dynamic Visions and Bongam.
- Court found much of Plaintiff’s documentary evidence admissible, but excluded (for now) certain hearsay: FBI agent recounting third‑party physicians’ statements that signatures were forged; the Court held forgery‑based claims and claims against Bongam individually in abeyance to allow Plaintiff to supplement with competent affidavits.
- Court granted summary judgment for the U.S. against Dynamic Visions on FCA false‑claim liability based on implied certification (claims submitted despite regulatory noncompliance), reserving damages calculation and claims tied to alleged forged signatures.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility / hearsay of investigator declarations and physicians’ statements | Declarations of FBI agents and Medicaid director are competent; physicians’ statements demonstrate forgery | Deem investigators’ and physicians’ statements hearsay and inadmissible at summary judgment | Agent and Medicaid director declarations mostly admissible or convertible to admissible trial evidence; physicians’ out‑of‑court statements re forgery are hearsay and excluded absent affidavits; forgery claims held in abeyance |
| Falsity — factual vs. certification theories | Claims were false because services were unauthorized and some were based on forged plans of care | Services were rendered; lack of authorization does not make claims factually false | Claims are not factually false on the mere lack of authorization; but are false under an implied‑certification theory because provider withheld noncompliance that was material to payment |
| Materiality of regulatory noncompliance | Authorization requirement is a condition of payment; DHCF policy/regulations and Medicaid director testimony show materiality | Argues insufficient rebuttal that violations would be material | Noncompliance with plan‑of‑care requirements was material to DHCF’s payment decision; materiality established and unrebutted |
| Knowledge / scienter and individual liability (Bongam) | Dynamic Visions acted knowingly or in reckless disregard (widespread, obvious defects; small operation; quality controls ignored); seek to hold Bongam individually or pierce veil | Denies forging, asserts compliance policies; disputes individual liability and control | Summary judgment for the U.S. against Dynamic Visions on implied‑certification liability (knowledge/recklessness shown); claims against Bongam and veil‑piercing held in abeyance pending additional affidavits |
Key Cases Cited
- Anderson v. Liberty Lobby, 477 U.S. 242 (summary judgment standard and drawing inferences)
- Matsushita Elec. Indus. Co. v. Zenith Radio, 475 U.S. 574 (summary judgment, nonmoving party must show genuine dispute)
- United States v. Sci. Applications Int’l Corp., 626 F.3d 1257 (D.C. Cir.) (framework for implied certification FCA theory)
- Universal Health Servs. v. United States, 136 S. Ct. 1989 (Sup. Ct.) (materiality standard for FCA implied‑certification claims)
- Gleklen v. Democratic Cong. Campaign Comm., 199 F.3d 1365 (F.3d) (summary judgment evidence must be convertible into admissible evidence)