The UNITED STATES of America EX REL. Michael L. DAVIS, Plaintiffs, v. The DISTRICT OF COLUMBIA, Defendant.
Civil Action No. 06-629 (JDB)
United States District Court, District of Columbia.
Signed March 31, 2014
JOHN D. BATES, United States District Judge
Finally, separate and apart from the fact that Mr. Hughes did not file his motion within a reasonable time, he has not made a showing of the “extraordinary circumstances” required for relief under
IV. CONCLUSION
Because Mr. Hughes has not shown that relief from judgment pursuant to Rules
SO ORDERED.
Jane Drummey, Office of Attorney General, Washington, DC, for Defendant.
MEMORANDUM OPINION
JOHN D. BATES, United States District Judge
Relator Michael L. Davis (“Davis“), brings this qui tam action on behalf of the United States against defendant the District of Columbia (“the District“), under the False Claims Act (“FCA“),
BACKGROUND
“It is common knowledge that Medicaid is a joint federal and state program that funds health care services for certain groups.” United States ex rel. Davis v. District of Columbia, 679 F.3d 832, 834 (D.C.Cir.2012). “Less well known is the process by which Medicaid funds are disbursed through local government to agencies to care for those in need and the safeguards in place to make sure that the proper amounts of funds are provided for services properly rendered.” Id. This case raises concerns about the cavalier process by which the District sought reimbursement for tens of millions of dollars in special education costs incurred by DCPS in the late 1990s.
A. Regulatory Background
Medicaid funds medical services for low-income and disabled individuals, and is jointly administered and funded by federal and state government agencies. See
Under federal Medicaid regulations, all states (and the District) must implement a “State Health Plan,” specifying minimum criteria for coverage and payment of Medicaid claims. See
Pursuant to the Medicare Catastrophic Coverage Act of 1998 and the Individuals with Disabilities Education Act (“IDEA“),
Under the District‘s Medicaid plan, DCPS is a certified clinical provider of IEP medical services for Medicaid-eligible special-education students. Def.‘s Stmt. ¶ 6. DCPS provides both medical services (e.g., medication, counseling, speech therapy, etc.) and transportation services (e.g., busing students between school and a medical clinic). DCPS is considered a “public provider” under the District‘s Medicaid plan, because it is a local government agency, rather than a private entity. See
The process by which DCPS obtains reimbursement for providing special-education services to Medicaid-eligible children is also complicated. During the fiscal year, MAA reimburses DCPS on an ongoing basis for the estimated costs of special education services.
These “interim” Medicaid reimbursements are based on estimated, fixed payments for different categories of services (e.g., $40 for a doctor‘s visit, $10 for a bus ride), but they often do not reflect the actual cost of such services. See
Under the District‘s Medicaid plan, MAA must review these annual filings at least once every two years and determine whether DCPS is owed additional funds or, alternatively, must return any overpayment. See District Medicaid Plan § 9(b)(3). A private, independent auditor generally performs this function, hired by MAA to review DCPS‘s year-end cost settlement claims. Davis, 679 F.3d at 834. For this reason, federal Medicaid regulations require DCPS to maintain financial data based on audit-quality documentation that allows “proper determination of costs payable.”
B. Factual Background
Davis & Associates is an accounting firm in the business of assisting public entities in obtaining reimbursement for Medicaid-eligible medical services. The District hired Davis & Associates to prepare its year-end Medicaid reimbursement cost-settlement reports in fiscal years 1995, 1996, and 1997. Def.‘s Stmt. ¶ 15. During those years, it apparently did so without incident. See
When Davis learned that DCPS was submitting the Maximus Reports to MAA, he contacted high-ranking District officials to notify them that only he had the required documentation to support DCPS‘s claims, meaning that the Maximus Reports could not possibly be documented adequately. See
Pursuant to federal regulations and the District‘s Medicaid plan, MAA hired an independent auditor, Bert Smith & Company (“Bert Smith“), to review DCPS‘s claims for fiscal years 1996 through 1998. See
C. Procedural Background
Davis filed this action on April 4, 2006, alleging that the District and DCPS violated the False Claims Act by submitting the fiscal year 1998 reimbursement claims without maintaining adequate supporting documentation. See Compl. [ECF No. 1]. Davis eventually filed an amended complaint, which alleges that the submission of the 1998 reimbursement claims without supporting documentation violated the FCA‘s prohibitions on knowingly presenting a false claim, Am. Compl. [ECF No. 82] ¶ 30, using a false statement to get a false claim paid,
On December 23, 2008, this Court granted in part and denied in part the District‘s motion to dismiss. See United States ex rel. Davis v. District of Columbia, 591 F.Supp.2d 30 (D.D.C.2008). The Court dismissed DCPS as a defendant, holding that it was “not a suable entity under the D.C. code.” Id. at 40. The Court also dismissed Davis‘s treble damages and conspiracy claims, finding that he had not alleged any actual damage to the federal government. See id. at 39-40. At the motion-to-dismiss stage, however, the Court rejected the District‘s argument that the Court lacked subject-matter jurisdiction under the FCA, because Davis qualified as an “original source” of the information leading to the alleged fraud. See id. at 36-37.
The parties proceeded with discovery, and Davis filed an amended complaint. The parties ultimately filed cross-motions for summary judgment, in which the District renewed its argument that the Court lacked subject-matter jurisdiction because Davis did not qualify as an “original source.” At the summary judgment stage, relying on United States ex rel. Findley v. FPC-Boron Employees’ Club, 105 F.3d 675 (D.C.Cir.1997), this Court agreed, and dismissed Davis‘s complaint for lack of subject-matter jurisdiction, holding that under Findley, he did not qualify as an
The D.C. Circuit affirmed in part and reversed in part. Regarding subject-matter jurisdiction, the D.C. Circuit held that “the policy judgment upon which [Findley] relied contradicts Rockwell‘s rationale,” Davis, 679 F.3d at 838, so in light of the Supreme Court‘s decision in Rockwell, the D.C. Circuit held that Davis “is an original source and that the district court has jurisdiction over his claims.” Id. at 839. On the issue of damages, the D.C. Circuit agreed that, even if the District had submitted claims without proper supporting documentation, “[t]he government got what it paid for and there are no damages.” Id. at 840. The D.C. Circuit did note, however, that Davis “still may be eligible to share in the statutory penalties assessed against the District,” should he prove that the District made one or more false claims. Id.
Back before this Court, the parties filed renewed cross-motions for summary judgment. The District included an argument that the D.C. Circuit chose not to rule on: that Davis‘s claims are barred by the FCA‘s six-year statute of limitations. On the issue of damages, Davis suggested that he was entitled to a civil penalty (in the amount of $5,500 to $11,000) for every interim claim incorporated within the Maximus Reports. See Pl.‘s Mot. for Summ. J. (“Pl.‘s MSJ“) [ECF No. 102] at 13. The District contested Davis‘s damages theory, and also argued—for the first time in its reply brief—that the Maximus Transportation Report is not a part of Davis‘s claim. In response, Davis sought leave to file a (lodged) sur-reply, which the District opposed. The motions are now fully briefed and ripe for resolution.
LEGAL STANDARD
Summary judgment is appropriate when the pleadings and the evidence demonstrate that “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.”
In determining whether there is a genuine dispute of material fact sufficient to preclude summary judgment, the Court must regard the non-movant‘s statements as true and accept all evidence and make all inferences in the non-movant‘s favor. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A non-moving party, however, must establish more than the “mere existence of a scintilla of evidence” in support of its position. Id. at 252.
DISCUSSION
Davis‘s claims expose very troubling behavior by the District, and are sufficient to establish liability under the False Claims Act. But even though the District violated the law, the federal government suffered no damages. This, combined with the fact that the statute of limitations bars a significant portion of Davis‘s claims, means that the District will get off relatively lightly in the end, owing a single civil penalty of $11,000.
I. THE MAXIMUS COST REPORT CLAIM IS BARRED BY THE STATUTE OF LIMITATIONS.
The District argues that any claims arising out of the District‘s submission of the Maximus Cost Report are barred by the FCA‘s six-year statute of limitations. See
The parties’ respective positions are simple. The District claims that the Maximus Cost Report was presented for payment to the MAA on January 12, 2000. Davis argues, on the other hand, that the record does not contain any admissible evidence to conclusively determine the date, so summary judgment on this issue is inappropriate. Davis is incorrect. His
Excerpt from Ex. E to Govt s MSJ at 1. The “RECEIVED” stamp on the cover of the Maximus Cost Report is clear as day, and reveals the date on which the MAA “RECEIVED” the report as January 12, 2000. In response, Davis does not explicitly dispute that the document was presented to MAA on January 12, 2000, nor does he offer an alternate date. Instead, he argues (correctly) that it is the District‘s burden to prove this affirmative defense with admissible evidence, see
To support summary judgment, evidence must generally be capable of being offered at trial in admissible form. See
Davis argues that the Maximus Report was not “kept in the ordinary course” of business, which would preclude its admission as a business record. See
But other evidentiary rules address these issues of admissibility of duplicates and originals, see
Finally, it seems that Davis himself has been a believer in the validity of the January 2000 date: his amended complaint alleges that “in January 2000, the DCPS Financial Officer ... submitted to the [MAA] a FY98 Special Education Medicaid reimbursement cost claim ... provided by Maximus.” Am. Compl. ¶ 15. Davis has not sought leave to amend that allegation. Having alleged in his complaint that the Maximus Cost Report was submitted in January 2000, and in light of the clear evidence in the record,5 Davis cannot avoid summary judgment on the statute-of-limitations issue now. Although this may be a factual dispute over a material fact, the dispute is not “genuine“—no reasonable jury, examining this record, could conclude that the Maximus Cost Report was submit-
One important caveat: this statute-of-limitations holding applies only to the Maximus Cost Report—it does not apply to the Maximus Transportation Report. As the District ultimately concedes, “the record does not reflect when Maximus‘s transportation cost settlement report was submitted to MAA, other than it was submitted sometime after January 12, 2000, and before May 23, 2000.” Def.‘s MSJ at 19. Accordingly, summary judgment would be inappropriate on that issue, because the District bears the burden of proving this affirmative defense. See
II. THE DISTRICT KNOWINGLY SUBMITTED A FALSE CLAIM.
The False Claims Act imposes civil liability against a defendant who: (1) presented a claim to the federal government for payment, (2) which was false, and (3) which the defendant knew was false. See
A. The District “Presented” A Claim For Payment To The Federal Government.
In previous stages of this litigation, the District argued that presentation of a reimbursement claim to the MAA—a District of Columbia government agency—could not lead to False Claims Act liability, because the claim for payment was not
In this round of summary judgment briefing, however, the District has seemingly abandoned this argument, and nowhere does it dispute Davis‘s argument that “[s]ubmission of the Maximus report[s] to MAA satisfies the False Claims Act requirement that claims be presented to the federal government.” Pl.‘s MSJ at 8. The District was wise to make this concession. Setting aside the ever-vexing question of how exactly the District of Columbia government fits into our federal scheme—particularly with respect to a joint federal and “state” program like Medicaid—the text of the False Claims Act conclusively refutes the District‘s previous position. As the statute read at the relevant time, the statutory definition of a “claim” includes any request or demand
... for money or property which is made to a contractor, grantee, or other recipient if the United States Government provides any portion of the money or property which is requested or demanded, or if the Government will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.
Under this legal framework, any reasonable jury would conclude that the District “presented” a false claim for payment to the federal government—through the MAA and its eventual reimbursement by CMS—within the meaning of the False Claims Act.
B. The District‘s Claim Was “False.”
Under the implied false certification theory of FCA liability, “a claim for payment is false when it rests on a false representation of compliance with an applicable federal statute, federal regulation, or contractual term,” where such “certification [is] a prerequisite to the government action sought.” Science Applications, 626 F.3d at 1266. The District‘s submission of the Maximus Transportation Report without possession of legally required supporting documentation satisfies this standard.
1. Physical Possession of Audit-Quality Documentation
The District‘s Medicaid plan allows for reimbursement of special-education costs only “in accordance with Medicare‘s Principles of Reasonable Cost Reimbursements described in 42 C.F.R. 413 Subparts A-G.” See District Medicaid Plan § 9(a)(1). Those federal Medicaid regulations, in turn, require health care providers to
So did the District, in fact, maintain such documentation? The record is clear: it did not. See, e.g., Def.‘s MSJ at 22; Ex C to Pl.‘s MSJ, Deposition of Isaac Woode [ECF No. 99-6] (“Woode Dep.“) at 34 (testifying that DCPS “didn‘t have the documentation“); Ex. D to Pl.‘s MSJ, Declaration of Isaac Woode [ECF No. 99-7] (“Woode Decl.“) ¶ 12 (“DCPS did not have the required service-specific documentation.“); Ex. I to Pl.‘s MSJ [ECF No. 99-12] (“CMS Review“) at 2 (CMS review of DCPS cost settlements explaining that “DCPS have not been able to produce all the requested information“). In fact, the District does not dispute the key fact here: the District did not have physical possession of the relevant documentation at the time DCPS submitted the Maximus Reports for payment. Instead, Davis & Associates had the documents, as Davis‘s firm had continued its work in preparing a fiscal year 1998 cost report that would never be submitted, due to the hiring of Maximus. See Def.‘s MSJ at 22 (criticizing Davis for retention of the documents, but implying that he has always had possession of them).8 This is a clear violation of both the District‘s Medicaid plan, see District Medicaid Plan § 9(a)(1), and federal Medicaid regulations, see
2. Constructive Possession Under An Implied Agency Theory
To solve this factual problem, the District tries a legal solution. It suggests that, because the District had previously hired Davis to help prepare the cost reports, and Davis had the supporting documentation in his possession, the District, therefore, constructively possessed the documents, under some sort of implied agency theory. See Def.‘s MSJ at 22.
This theory has at least two flaws. First, no evidence in the record supports the District‘s assertion that the Maximus Reports were prepared or submitted in reliance on documents in Davis‘s possession. This implied agency theory—fully developed for the first time in the District‘s reply brief—appears to have been constructed solely for the purpose of defending the District‘s actions after the fact, divorced from the facts of what actually happened. Tellingly, the District‘s arguments in this regard are largely unaccompanied by citations to evidence in the summary judgment record. Conclusory assertions like these are insufficient.
Second, the District has not demonstrated the existence of an implied agency relationship between Davis and the District that would have justified the District‘s reliance on documents in Davis‘s possession—even if any facts suggested that the District did so rely. By the time DCPS submitted the Maximus Reports to MAA in January 2000, the District had already fired Davis, and hired Maximus to prepare its cost reports. See, e.g., Ex. O to Pl.‘s
To be sure, if the District could point to some contractual arrangement (implicit or explicit) that required Davis to assist Maximus (its successor and competitor), in future preparation, submission, and validation of Medicaid cost settlement reports, that might change the analysis. But the District has presented no such evidence.9 And as Davis points out, it is very difficult to demonstrate an implied agency relationship based on a past course-of-conduct (and hopes for gratuitous continuation of that conduct) under the common law of the District of Columbia. See, e.g., Davey v. King, 595 A.2d 999, 1001-03 (D.C.1991) (reversing trial court‘s finding of an implied agency relationship based on putative principal‘s unjustified expectation of a continued course of gratuitous conduct); Tauber v. Jacobson, 293 A.2d 861, 867 (D.C.1972) (“It is well established that mere expectancy of a continued course of conduct is not enough.“). No such showing has been made here, and the District makes no effort to engage with this case law. Hence, when the District ended its contractual relationship with Davis and replaced his firm with Maximus, it forfeited the right to rely on documents in Davis‘s possession, absent some indication that the parties had agreed on such an arrangement. There being no such indication here, the District‘s implied agency argument fails.
3. Materiality
To satisfy the “falsity” element “under an implied certification theory, the plaintiff must prove by a preponderance of the evidence that compliance with the legal requirement in question is material to the government‘s decision to pay.” Science Applications, 626 F.3d at 1271. Davis carries this burden. He points to persuasive evidence in the summary judgment record that supports the (intuitive) notion that the federal government would refuse to reimburse for medical services if it knew that those services were not supported by the requisite documentation, specifically called for in both the federal Medicaid regulations, see, e.g.,
The District offers one sentence of argument in response: “Davis cannot show that any provision violated by the District is material for payment of its claims.” Def.‘s Mot. at 24. This sentence is accompanied by no citations. Even assuming that one conclusory sentence is sufficient to preserve the District‘s materiality argument, but see Schneider v. Kissinger, 412 F.3d 190, 200 n. 1 (D.C.Cir.2005) (“It is not enough merely to mention a possible argument in the most skeletal way, leaving the court to do counsel‘s work.“), it is unpersuasive, and insufficient to create a genuine dispute of material fact. The requirement to maintain audit-quality supporting documentation for Medicaid reimbursement requests is far from a “merely ancillary” contractual or regulatory requirement that can be excused as immaterial. See Science Applications, 626 F.3d at 1271 (“Payment requests by a contractor who has violated minor contractual provisions that are merely ancillary to the parties’ bargain are neither false nor fraudulent.“). The District‘s non-compliance with the documentation requirement was material, and, for all the reasons set forth above, the Maximus Transportation Report was implicitly “false.”
4. Other Arguments Against The Implied False Certification Theory
The District includes a “catch-all” section in their briefing, under the heading “The Theory of Implied False Certification Does Not Apply.” Def.‘s MSJ at 22. But these arguments, too, are unpersuasive. For example, in an argument that is flatly inconsistent with its other submissions, the District at times suggests that it did, in fact, have possession of all requisite documentation. In a conclusory footnote, the District claims:
The assertion that the District lacked any supporting documentation is clearly disputed by the District‘s deposition testimony and documents, which show that DCPS did have supporting documentation in its possession at the time it submitted the FY 1998 cost reports and in 2003. As the District has shown, all supporting documentation for the transportation cost report is in its possession.
Def.‘s MSJ at 23 n.14; see also
Finally, the District tries to draw a distinction between the documentation required to support a claim for reimbursement for medical services and for transportation services, asserting (again, without citation) that less documentation is required for reimbursement for transportation services. But nothing in the record supports this theory. On the other hand, Davis‘s response—that claims for reimbursement for transportation services require the same documentation that is used to support claims for reimbursement for medical services—does find support in the record. See Ex. F to Pl.‘s MSJ, Deposition of Dorothy Page Proctor [ECF No. 99-9] (“Proctor Dep.“) at 35 (testifying that reimbursement for transportation services is paid only if the District verifies “that a service was performed and the student was on the bus that day,” and that if verification is lacking “we throw out that claim“). Once again, Davis‘s version of events is the only one supported by the summary judgment record.
C. The District Submitted The False Claim “Knowingly.”
The FCA defines the requisite mental state of a “knowing” violation as a violation by someone with “actual knowledge,” “deliberate ignorance,” or “reckless disregard” of the truth or falsity of the claim.
Davis argues that the District submitted the false claim “knowingly,” as evidenced by his repeated conversations with high-ranking employees of the District, warning them that the Maximus Reports could not have been properly documented, because only Davis had the documentation. The record supports Davis‘s contentions. See Ex. J to Pl.‘s MSJ, Statement of Michael L. Davis [ECF No. 99-13] (“Davis Stmt.“) at 2 (“[Davis & Associates] contacted the DCPS CFO to inform him that Maximus had not been the DCPS Medicaid contractor for FY98, and therefore had no documentation to support such a claim.“); see also
The District‘s response is a narrow one. It does not dispute that high-level managers at DCPS and the District received stern warnings from Davis about the lack of documentation. Instead, the District argues that, even if it knew that it did not have the supporting documentation, any false claim was still not made “knowingly,” because the District felt it could rely on the fact that Davis, its former contractor, possessed the documents. See Def.‘s MSJ at 22 (“The District‘s reliance on Davis‘s
Of course, this is simply another bite at the apple for the implied agency argument the Court has rejected in considering the “falsity” element. In truth, it is mostly non-responsive to the question of whether the false claim was made “knowingly.” And for the reasons explained above, any reliance on the contractor it had already fired—even if it were, counterfactually, supported by evidence in the record—would have been unjustified.
But again, on the relevant question—that is, what the District knew and when—the District offers nothing. No argument, no record evidence—nothing. So in light of Davis‘s well-supported arguments on the “knowingly” element, and the District‘s failure to meaningfully respond, summary judgment in favor of Davis is appropriate.
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For the reasons set forth above, Davis has offered evidentiary support for all elements of the “implied false certification” theory of False Claims Act liability. The District‘s responses, on the other hand, generally find little or no support in the summary judgment record. Hence, there is no genuine dispute of material fact regarding the District‘s “knowing” “presentment” of a “false” claim for payment to the federal government, and the Court will grant summary judgment in favor of Davis with respect to his FCA claim arising out of the Maximus Transportation Report.10
III. THE FEDERAL GOVERNMENT SUFFERED NO DAMAGES.
All of Davis‘s claims are predicated on the lack of proper documentation to support reimbursement claims—he “does not allege that any services paid for were not provided.” Davis, 679 F.3d at 840; see also id. (“The sole defect Davis claims is the failure to maintain documentation for those services.“). Nevertheless, in previous stages of this drawn-out litigation, Davis argued that “the United States Treasury has suffered millions of dollars in damages,” Am. Compl. ¶ 24, because the federal government would not have paid any reimbursement if it knew that the District did not maintain proper documentation. Indeed, even in this round of summary judgment briefing, Davis tries a softer version of this argument, suggesting in an ambiguous footnote that the government “suffered damages” notwithstanding “the eventual reimbursement of $7,601,381” and the fact that all of the billed services actually were provided. See Pl.‘s Mot. at 11 n.6.
But the D.C. Circuit was clear: “the government suffered no damages.” Davis, 679 F.3d
IV. THE DISTRICT OWES ONE CIVIL PENALTY.
Although Davis is not entitled to compensatory damages, the D.C. Circuit correctly noted that Davis “still may be eligible to share in the statutory penalties assessed against the District.” Davis, 679 F.3d at 840. Because the District submitted an impliedly false claim when it presented the Maximus Transportation Report for payment without possession of the federally required supporting documentation, the District is liable for civil penalties.
The next question: how many false “claims” did the District submit? Davis seeks a $5,500 to $11,000 civil penal-
ty for every interim claim paid to DCPS during the relevant time period—all 399,960 of them, for a grand total of anywhere between $2,199,780,000 and $4,399,560,000 in civil penalties. Unsurprisingly—considering the high-end estimate of $4.4 billion in damages is more than double the yearly budget of DCPS12—the District takes issue with those calculations, and argues that, “at most, the District should be liable for a single civil penalty.” Def.‘s MSJ at 24.
The Court agrees with the District. These “interim” claims are not final, and are not based on the actual cost of the services provided. See Def.‘s Stmt. ¶¶ 9-10. Moreover, they are not presented to the federal government piecemeal; rather, they are aggregated and submitted for reimbursement collectively at the end of the year, in final form. The Supreme Court and the Second Circuit have suggested that “the number of assertable FCA claims is not measured by the number of contracts, but rather by the number of fraudulent acts committed by the defendant.” Kreindler, 985 F.2d at 1157 (citing United States v. Bornstein, 423 U.S. 303, 311, 96 S.Ct. 523, 46 L.Ed.2d 514 (1976)). Here, DCPS committed a fraudulent act when it presented year-end cost settlement reports for payment, despite the lack of supporting documentation, but not every single time an interim claim was paid during each fiscal year. That means that the Maximus Transportation Report represents one false claim, for which the Dis-
Although this outcome seems clear enough, it is worth noting that under Davis‘s theory, the District would be liable for billions of dollars in civil penalties, even though the federal government suffered no financial harm. When faced with two potential interpretations of the statutory phrase “a false or fraudulent claim,”
Hence, the District is liable for one civil penalty, within the range of $5,500 to $11,000. See
CONCLUSION
For the reasons set forth above, the Court will grant in part and deny in part the parties’ cross-motions for summary judgment. A separate order accompanies this Memorandum Opinion.
Civ. Action No. 12-2013 (EGS)
United States District Court, District of Columbia.
Signed March 31, 2014
