Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTERJohnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER
Keith JOHNSON, M.D., Bringing this action on behalf of the United States of America, Laura Schmidt, R.N., Bringing this action on behalf of the United States of America, Plaintiffs,
v.
THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, Strong Memorial Hospital, Defendants.
United States District Court, W.D. New York.
*262 Christina A. Agola, Rochester, NY, for Plaintiffs.
Thomas S. D'Antonio, Ward, Norris, Heller & Reidy, LLP, Rochester, NY, for Defendant.
DECISION AND ORDER
DAVID G. LARIMER, District Judge.
This is an action under the False Claims Act,
Plaintiffs' complaint sets forth three causes of action. In Count I, plaintiffs allege that defendants committed fraud pursuant to
Defendants have moved to dismiss the amended complaint for failure to plead fraud claims with the particularity required by
FACTS
The Hospital is a teaching hospital owned and operated by URMC. Plaintiff Johnson was a medical resident who worked at the Hospital between July 2004 and October 2006, when he was terminated on the alleged grounds of dishonesty and incompetence. Plaintiff Schmidt was employed by the Hospital for fourteen years as an operating room nurse, from 1984 through June 2006, when her employment was terminated.
DISCUSSION
In deciding whether plaintiffs' complaint should go forward, I note that there are several principles which apply simultaneously to the examination of a motion to dismiss under these circumstances.
With respect to the specificity of the stated claims, the Federal Rules of Civil Procedure generally demand only "notice" pleading, with allegations sufficient to put the responding defendants on notice as to the general nature of the claim. However, where, as here, the complaint sounds in fraud, a more rigorous standard is applied.
Additional concerns also come into play. The plaintiffs' claims are asserted pursuant to the False Claims Act, which allows private citizens, acting as private attorneys general, to commence litigation relating to fraud committed against the government. The purpose of the statute is to encourage citizens to act as "whistle blowers" and to assist in exposing fraud against the government. See United States ex rel. Dick v. Long Island Lighting Co.,
I. Plaintiffs' Fraud Claims
Defendants argue that the plaintiffs have presented only general allegations and have failed to detail any false claims allegedly submitted by defendants, and therefore have failed to plead their fraud claims with sufficient specificity to satisfy
The complaint alleges a quotidian pattern wherein the Hospital compelled or permitted violations of the hospital's policy and Medicare/Medicaid regulations which require the presence or supervision of a teaching or attending physician (collectively, "TP") when certain procedures are performed by residents. Plaintiffs allege that the pertinent Medicare/Medicaid regulations make reimbursement for such procedures by residents contingent upon TP supervision.
The complaint identifies the general time period and frequency of the alleged failures to provide a supervising TP, some of the medical procedures for which TPs were not provided, and the names of various Strong faculty physicians who actively participated in, or else condoned, the practice. Plaintiff Johnson estimates that he performed several hundred epidurals and well over one thousand extubations or emergence procedures without the supervision of a TP, and that TPs rarely, if ever, filled out post-operative reports as required by statute. Both plaintiffs describe *265 a number of examples of anesthetic procedures in which TPs were absent or unavailable to supervise residents performing procedures for which supervision was required, and state that they observed, or were instructed by TPs to author, falsified records indicating TP supervision in cases where there had been none.
Johnson states that in or about April 2005, he confronted Dr. Lustik concerning the fact that this practice was in violation of Medicaid and Medicare billing procedures, and began adding notations to medical records to indicate procedures for which TP had not been present. In November 2005, a memorandum was sent to anesthesiology residents and at least one verbal instruction was given, warning residents to discontinue notating the charts of patients for whom procedures had been performed without a TP.
Ultimately, after an incident in which Johnson refused to perform an epidural outside the presence of a TP, and attempted to procure one himself to oversee the procedure, Johnson was investigated by URMC, and his employment was eventually terminated.
Plaintiff Schmidt describes having specifically witnessed plaintiff Johnson and other residents performing services without the presence of a TP, and testifies that she was routinely required to sign falsified medical records for those procedures, which stated that a TP had been present. Schmidt recalls an incident in 2005, wherein Dr. Chibber asked her to alter medical records to falsely indicate the presence of a TP, and when she refused, was told that "we won't be able to bill for the case if there was no attending." Schmidt replied, "well I guess it's a freebie." Schmidt states that after this episode, she feared for her employment and cooperated with subsequent instructions to alter medical records. Several months later, Schmidt was terminated from her fourteen-year employment with URMC.
Clearly, the complaint's allegations, taken as true, establish that the Hospital was routinely failing to ensure the presence of a TP at certain procedures, and fabricating patient reports to falsely indicate that TPs were present. The parties do not appear to dispute that if the plaintiffs had plausibly alleged that such procedures were later presented to Medicare or Medicaid for payment, their claims might have been sufficiently stated. The difficulty, however, lies in plaintiffs' glaring failure to even allege that bills for any of those procedures were ever presented to Medicare/Medicaid for payment.
The central question under the False Claims Act is whether the defendant actually presented a "false or fraudulent claim" to the government. See Harrison v. Westinghouse Savannah River Co.,
Nonetheless, plaintiffs appear not to have seen the proverbial forest for the trees. The plaintiffs' claims are set forth in a behemoth fifty-five page, 183-paragraph complaint (Dkt. #2), the majority of which is devoted to lengthy descriptions of *266 the hospital's repeated failure to provide TP supervision, and its efforts to falsely indicate TP supervision on patient records. Nowhere in their lengthy pleading do the plaintiffs allege or describe how, or even if, any bills for procedures involving falsified records were ever presented to Medicare or Medicaid for payment. Indeed, plaintiffs do not even allege that any of the falsified records related to Medicaid or Medicare patients. As such, the plaintiffs' fraud claims do not state a claim, but merely speculate that a claim might exist. See United States ex rel. Smith v. N.Y. Presbyterian Hospital,
Although the specificity requirements of
Courts have also permitted a "relaxed rule of pleading" under
Here, the plaintiffs respectively allege that hundreds of procedures were performed without the TP supervision required by Medicare/Medicaid over a two year and fourteen-year period, ending with the plaintiffs' terminations in 2006. While the lengthy time period and sheer number of potential claims may handicap the plaintiffs' ability to specifically detail each incident of fraud and reduce their burden of proof accordingly, it does not relieve them of the obligation to plead the necessary elements of fraud altogether. The submission of a false claim to the government is the cornerstone of any fraud claim pursuant to the FCA. See Polansky,
The danger of permitting unsupported and insufficiently alleged fraud claims to proceed based solely on a party's lack of access to evidence is obvious. "[T]he particularity requirement of
In deference to these principles, district courts in this Circuit, when presented with facts markedly similar to those here, have dismissed the claims of FCA relators who allege noncompliance with Medicare/Medicaid regulations, but cannot identify or describe any particular false claims that were presented to the government for payment. In Smith v. Yale Univ.,
Smith's claims against the New York-based defendants, New York Presbyterian Hospital and Cornell University, were ultimately transferred to the district court for the Southern District of New York, on the grounds that was a more appropriate venue, with proper jurisdiction to hear the matter. United States ex rel. Smith v. Yale Univ.,
In appraising the facts here, which are similar to the Smith matter in a number of significant respects, I find that whether viewed under a "relaxed" standard or under the heightened standard of
II. Plaintiffs' Claim for Retaliatory Discharge
The plaintiffs also seek relief for retaliatory discharge pursuant to
[a]ny employee who is discharged ... by his or her employer because of lawful acts done ... in furtherance of an action under [the FCA], including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under this section, shall be entitled to all relief necessary to make the employee whole.
To sustain an action for retaliation under
Both plaintiffs allege that they complained, informally and on multiple occasions, to physicians about the Hospital's failure to provide TP supervision for certain procedures that required it. Johnson states that his complaints, including a complaint to Dr. Lustik that identified the Hospital's conduct as violative of Medicare/Medicaid regulations, and his attempts to annotate patient records where TPs were absent in order to protect himself from liability if there was a problem with the procedure, ultimately resulted in his termination. Plaintiff Schmidt states that her complaints about the lack of TP supervision and falsification of patient records resulted in a confrontation with Dr. Chibber, who protested that if Schmidt did *269 not agree to falsifying patient records, the procedures could not be "billed."
However, the plaintiffs do not allege that their complaints were made in furtherance of this or any other qui tam action, or that they were part of an investigation by either plaintiff into Medicare/Medicaid fraud. See Vallejo,
Furthermore, even assuming that the plaintiffs' complaints to TPs were deemed to be protected conduct, plaintiffs plead no facts which suggest that they complained to hospital administrators or high level personnel, or that the defendantsthe Hospital and the URMCwere otherwise aware that the plaintiffs were engaging in any protected activity whatsoever relating to Medicare/Medicaid fraud. See Vallejo,
III. New York State Whistleblower Act
Although the plaintiffs' complaint lists the New York State Whistleblower Act,
IV. Plaintiff Johnson's Motion to Amend the Complaint
Plaintiff Johnson seeks to amend the complaint to add Dr. Lustik as a defendant and assert claims for libel per se and prima facie tort against him and all of the original defendants. (Dkt. #18).[1] The *270 allegedly tortious and defamatory statement is comprised of a "Verification of Post Graduate Medical Education" form ("Verification Form") which Dr. Lustik completed and forwarded to certain medical authorities in the state of Delaware (the "Delaware Board"). The Verification Form required Dr. Lustik to describe any disciplinary proceedings against Johnson, and Dr. Lustik did so by attaching a copy of a November 15, 2006 memorandum from Johnson's final employment evaluation, which summarized disciplinary proceedings against Johnson by URMC. Specifically, Johnson contends that: "Dr. Lustik, despite being previously warned to cease and desist targeting Relator Johnson nonetheless saw fit to publish, in or about the summer of 2008, unsolicited, a negative reference to the State of Delaware Board of Medical Practice, dated November 15, 2006 ..." (Dkt. #18, Att. 2 at 3) (emphasis in original).
While leave to amend a complaint is to be freely given under ordinary circumstances, it is properly denied for good cause, including where amendment would be futile, or where the proposed amendment is made in bad faith. See generally
I find that Johnson has failed to demonstrate any entitlement to amend his complaint. Indeed, his proposed claims appear to have been asserted both frivolously and in bad faith. Johnson has tellingly made no attempt to refute or otherwise respond to defendants' contention that the allegedly libelous and tortious Verification Form was not completed by Dr. Lustik "unsolicited," as plaintiff asserts. (Dkt. #18, Att. 2 at 3) (emphasis in original). To the contrary, Dr. Lustik completed and published the form at the request of plaintiff's own counsel, who sent the form to Dr. Lustik with the instruction that he complete it and forward it to the Delaware Board. At the behest of a cautious Dr. Lustik, plaintiff twice executed explicit authorizations for the allegedly defamatory statement to be released. First, Johnson signed a release authorizing Dr. Lustik to provide his "final [employment] evaluation, including the attachment dated November 15, 2006," to his counsel. (Dkt. #19, Att. 1, Exh. C). Some sixteen months later, in connection with his counsel's request to Dr. Lustik to complete the Verification Form and forward it to the Delaware Board, Johnson completed a second authorization for Dr. Lustik's "release of the [Verification Form], including the attachment dated November 15, 2006." (Dkt. #19, Att. 1, Exhs. D, E). Now, Johnson inexplicably seeks to hold Dr. Lustik liable for the publication of a Verification Form which Johnson and his counsel asked Dr. Lustik to prepare, authorized to be released with full knowledge that the November 15, 2006 statement was attached, and in fact requested that Dr. Lustik publish in the precise manner of which Johnson now complains.
Johnson's counsel, Ms. Agola, knew full well that Dr. Lustik did not "see fit to publish [the Verification Form and its attachment] "unsolicited," as she attests in an accompanying affidavit. (Dkt. #18, Att. 2 at 1, 3) (emphasis in original). She knew *271 that Dr. Lustik's publication of the document had been procured and orchestrated entirely by hera fact which contradicts the allegations of the proposed amended complaint and which is glaringly omitted from it. Such conduct smacks of bad faith.
In any event, Johnson's proposed claims fail as a matter of law. It is well-settled in the state of New York that Johnson's release provides a complete defense for Dr. Lustik against Johnson's libel per se claim and a probable defense against his prima facie tort claim, and furthermore Johnson has failed to plead the necessary element of special damages in connection with his prima facie tort claim. See e.g., Restatement (Second) of Torts § 583 ("the consent of another to the publication of defamatory matter concerning him is a complete defense to his action for defamation"); Curiano v. Suozzi,
Accordingly, I conclude that amendment of the complaint would be inappropriate in light of plaintiff's demonstrated bad faith, and would in any event be futile.
V. Defendants' Request for Sanctions Pursuant to Fed. R. Civ. Proc. 11(b)(3)
The defendants have asked the Court to impose sanctions on plaintiff Johnson and his counsel for attempting to introduce, as discussed above, an amended pleading that includes allegations wholly lacking in evidentiary and legal support.
CONCLUSION
For the foregoing reasons, I find that plaintiffs have failed to sufficiently plead their claims for fraud and/or retaliation pursuant to the FCA. Defendants' motion to dismiss (Dkt. #14) is therefore granted, and the complaint is dismissed. Plaintiff Johnson's motion to amend the complaint (Dkt. #18) is denied as frivolous and in bad faith. Defendants' request for sanctions pursuant to
IT IS SO ORDERED.
NOTES
Notes
[1] While the Court has the discretion to decline to exercise jurisdiction over the new claims based on the dismissal of all of the plaintiffs' extant federal law claims, given the patent frivolity of plaintiffs' proposed new claims I opt to dispose of them now in the interest of judicial economy and convenience, rather than subject the parties to additional, unnecessary litigation. See Glewwe v. Eastman Kodak Company,