United States of America et al v. Bluewave Healthcare Consultants Inc et al

Filing 634

ORDER AND OPINION granting in part and denying in part 500 Mallory's Motion for Summary Judgment. Latonya Mallory's motion for summary judgment is granted with regard to Lutz and Webster's claims arising under insurance statutes inCalifornia and Illinois. Mallory's motion for summary judgment is denied as to all other claims. AND IT IS SO ORDERED. Signed by Honorable Richard M Gergel on 8/29/2017.(sshe, )

IN THE UNITED STATES DISTRICT COURT
DISTRICT OF SOUTH CAROLINA

United States of America, et al.,
Plaintiffs,
ex rel. Scarlett Lutz, et al.,

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Plaintiffs-Relators,
V.

Berkeley Heartlab, Inc., et al.,

Civil Action No. 9: 14-cv-00230-RMG
(Consolidated with 9:11-cv-1593-RMG and
9:15-cv-2458-RMG)

ORDER and OPINION

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Defendants.
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This matter is before the Court on defendant Latonya Mallory's motion for summary
judgment of Relators Scarlett Lutz and Kayla Webster's Third Amended Qui Tam Complaint.
(Dkt. No. 500.) Lutz and Webster have filed a response in opposition (Dkt. No. 519), and
Mallory has filed a reply (Dkt. No. 529). For the reasons set forth below, Mallory's motion for
summary judgment (Dkt. No. 500) is granted in part and denied in part.
I.

Background

On February 6, 2013, Relators Lutz and Webster filed a qui tam complaint 1 alleging that
several defendants including Blue Wave Health Care Consultants, Inc. ("Blue Wave"), Health
Diagnostics Laboratory ("HDL"), Singulex, Inc., and several individuals including Defendants
Mallory, Floyd Calhoun Dent, III, and Robert Bradford Johnson orchestrated a nationwide

1

On July 9, 2014, Lutz and Webster filed a First Amendment Complaint in which they named
Mallory, Dent, and Johnson as defendants. Lutz and Webster filed a Second Amended Complaint
on October 29, 2014 with the same factual allegations raised in the original and First Amended
Complaints. (Dkt. No. 40-1.) On April 4, 2016, Lutz and Webster filed a Third Amended
Complaint reinserting claims under some state false claims acts that they inadvertently omitted
from the Second Amended Complaint.

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scheme to offer and pay kickbacks to physicians who ordered HDL and/or Singulex tests in
violation of the federal False Claims Act ("FCA"), 42 U.S.C. § 3729, the Anti-Kickback Statute
("AKS"), 42 U.S.C. § 1320a-7b(b), various state false claims acts, and insurance fraud statutes in
California and Illinois. Specifically, Relators allege the defendants' financial relationships with
physicians provided financial incentives for the use of their laboratory services and resulted in
billing private insurers for medically unnecessary testing services, in violation Section 1871.7(a)
of the CIFPA, Cal. Ins. Code 1871.7(a), and Section 92/5(a) of the ILCFPA 740 Ill. Comp. Stat.

§ 92/5(a). (Dkt. No . 275 at 11). Relators also allege that defendants conspired to commit
violations of the federal and state false claims acts. (Dkt. No. 275 at 10.)
Mallory filed this motion for summary judgment on June 23, 2017. (Dkt. No. 500.) The
Court has since granted Relators' motion to dismiss many of their state law claims. (Dkt. No.
608 .) Relators' remaining claims against Mallory arise under

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false claims acts of Colorado,

Florida, Illinois, Indiana, North Carolina, and Virginia and under insurance fraud statutes in
California and Illinois. (Dkt. No. 595 at 1-2.) Mallory has moved for summary judgment on all
of Relators ' remaining state law claims. (Dkt. No. 500.)

II.

Legal Standard
A. Summary Judgment
To prevail on a motion for summary judgment, the movant must demonstrate that there is

no genuine issue of any material fact and that the movant is entitled to judgment as a matter of
law. Fed. R. Civ. P. 56(a). The party seeking summary judgment has the burden of identifying
the portions of the "pleadings, depositions, answers to interrogatories, any admissions on file,
together with the affidavits, if any, which show there is no genuine issue as to any material fact

that the moving party is entitled to judgment as a matter of law." Celotex Corp. v. Catrett, 477
U.S. 317, 322 (1986). The Court will construe all inferences and ambiguities against the movant
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and in favor of the non-moving party. US. v. Diebold, Inc., 369 U.S. 654, 655 (1962). The
existence of a mere scintilla of evidence in support of the non-moving party's position is
insufficient to withstand a motion for summary judgment. Anderson v. Liberty Lobby, Inc., 4 77
U.S. 242, 252 (1986). However, an issue of material fact is genuine if the evidence is such that a
reasonable jury could return a verdict in favor of the non-movant. Id. at 257.
"When the moving party has carried its burden under Rule 56( c), its opponent must do
more than simply show that there is some metaphysical doubt as to the material facts."

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 4 75 U.S. 574, 586 (1986). "In the language
of the Rule, the nonmoving party must come forward with 'specific facts showing that there is a
genuine issue for trial."' Id. at 587. "Where the record taken as a whole could not lead a rational
trier of fact to find for the non-moving party, there is no 'genuine issue for trial."' Id. (quoting

First Nat '! Bank ofAriz. v. Cities Serv. Co., 391 U.S. 253, 289 (1968)).
B. False Claims Act

In order to establish a violation of the False Claims Act, a plaintiff must show that: (1)
there was a false statement or fraudulent course of conduct; (2) made or carried out with the
requisite scienter; (3) that was material to the government's decision to pay a claim; and (4) that
caused the government to pay out money or to forfeit moneys due. See United States ex rel.

Wilson v. Kellogg Brown & Root, Inc., 525 F.3d 370, 376 (4th Cir. 2008). The state false claims
acts at issue here generally mirror the federal FCA. (Dkt. No. 275 at 42, explaining that " [t]he
false claims acts of the sovereign States of North Carolina, California, Colorado, Delaware,
Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Michigan, Minnesota, New Jersey, New
York, Tennessee, Texas, Virginia, and Wisconsin generally mirror the federal FCA").

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III.

Discussion
A.

Intervened Federal FCA Claims

The United States has intervened in all of Lutz and Webster's claims against Mallory that
arise under the federal FCA. Because the Government bears responsibility for prosecuting those
claims under 31 U.S.C. § 3730(c)(l), the Court will consider Mallory's arguments about those
claims in its order on Mallory's motion for summary judgment on claims in the Government's
Complaint in Intervention. (Dkt. No. 498.)
B.

Non-Intervened State Law Claims
1.

False Claims

Mallory argues she is entitled to summary judgment on Lutz and Webster's nonintervened state claims because Relators have provided no evidence that (1) Mallory's conduct
and statements were material to states' or private insurers' decisions to pay claims; (2) states or
private insurers actually paid claims submitted by HDL or Singulex; or (3) Mallory's conduct
caused the states or private insurers to pay claims. (Dkt. No. 500-1.)
a.

Materiality

Mallory argues that her alleged state false claims act violations were not material to
states' or private insurers' decisions to pay because the federal government continued to pay
claims despite having knowledge of Mallory's conduct. (Dkt. No. 500-1 at 3.) This assertion
concerns the federal government's knowledge and continued payment of claims, so it is not
relevant to the materiality of individual states' decisions to pay claims submitted by HDL or
Singulex.
Mallory also argues that the alleged kickback scheme was not material to states'
decisions to pay claims even if it was technically illegal. (Dkt. No. 519 at 8-9.) Mallory notes
that on March 23, 2010, the federal AKS was amended to state that "a claim that includes items

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or services resulting from a violation of [the AKS] constitutes a false or fraudulent claim." 42
U.S.C. § 1320a-7b(g), as amended by the Patient Protection and Affordable Care Act, Pub. L.
no . 111-148, 124 Stat. 119 (2010), effective January 1, 2011. Mallory claims that the
corresponding statutes in North Carolina, Colorado, Florida, Illinois, Indiana, and Virginia do
not include the same explicit notification that claims tainted by illegal kickbacks are false claims.
(Dkt. No. 529 at 5.) The Court does not agree with Mallory's premise that the 2010 amendment
to the federal AKS made compliance with the AKS material to FCA violations and is persuaded
that the 2010 amendment was simply a clarification of existing law. See U.S. ex rel.
Westmoreland v. Amgen, Inc., 812 F. Supp. 2d 39, 54 (D. Mass. 2011).

In any event, commonsense and the weight of analogous 2 authority considering the
materiality of AKS violations within the context of the federal FCA suggests that evidence that
claims are tainted by an illegal kickback scheme in which providers are bribed for referrals
would be material to a state's decision to pay claims. See, e.g., United States ex rel. United
Health Group, Inc., 659 F.3d 295, 313 (3d Cir. 2011); United States ex rel. Nevyas v. Allergan,
Inc., 2015 WL 4064629, at *4 (E.D. Pa. Jul. 2, 2015); United States ex rel. Gale v. Omnicare,
Inc., 2013 WL 3822152, at *5 (N.D. Ohio Jul. 23, 2013); United States ex rel. Fry v. The Health
Alliance of Greater Cincinnati, 2008 WL 5282139, at *33 (S.D. Ohio Dec. 18, 2008); United
States ex rel. Bidani v. Lewis, 264 F. Supp. 2d 612, 615-16 (N.D. Ill. 2003). A violation of the

anti-kickback statute is not a technical violation of the law.
Finally, as the question of materiality is both fact-intensive and context-specific and the
Court finds that there is at least a genuine dispute of material fact here, the question should be
presented to a jury. See Westmoreland, 812 F. Supp. 2d at 46.

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As explained above, the state false claims acts at issue here generally mirror the federal FCA.

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b.

Payment

Mallory claims there is no evidence that any state or private insurer disbursed or forfeited
money and that Lutz and Webster both testified that they had no personal knowledge of any
HDL or Singulex claims that were presented to and paid by state Medicaid programs or private
insurers with patients residing in California or Illinois. (Dkt. No. 500-1 at 4.) Lutz and Webster
claim that the law does not require them to have personal knowledge of presentment and
payment but allows them to rely on claims data showing presentment and payment of claims.
Lutz and Webster have subpoenaed HDL ' s claim submissions to Medicaid programs in
Colorado, Florida, Indiana, Illinois, North Carolina, and Virginia (Dkt. No. 619 at 6) and
produced that data to Mallory in May and June 2016.3 (Dkt. No. 519, Exhibits 1-11.) This data
shows that HDL submitted and was reimbursed by state Medicaid programs for laboratory
testing services.

c.

Causation

With regard to causation4 , Mallory argues that the Relators cannot rely on statistical
sampling to prove liability or damages but instead must show a direct link between defendants '
financial arrangements and each of the allegedly false claims submitted to state governments.
Mallory claims that rejecting statistical sampling in favor of subjecting each claim to analysis
and cross examination is "crucial" in this case because not all of the physicians or physician
practices that had a P&H agreement with HDL actually received P&H fees. (Dkt. No. 500-1 at
6.)

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Relators had not obtained the Colorado business records at the time of briefing but represented
that they expected to have those records by July 21 , 2017. (Dkt. No. 519 at 6.)
4

Mallory weaves this argument throughout her motion for summary judgment.

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The Government took great care to ensure that its damages expert isolated only those
claims that could be directly linked to P&H fees paid to physicians. (Dkt. No. 522 at 24-26.) The
Relators do not appear to have exerted the same effort to show which physicians who ordered
HDL tests actually received P&H payments. (Dkt. No. 529 at 4.) Mallory claims that in excess of
40% of HDL ' s customers did not receive P&H payments at all. (Dkt. No. 529 at 4.) The Court
reads this as a tacit admission that the majority of HDL ' s customers did receive P&H fees.
Moreover, Relators have provided defendants with documentation of all claims submitted by
HDL to the six states 5 during the relevant period, and that documentation identifies each
referring provider. Despite having this information, Mallory does not argue that all of the claims
HDL submitted to state Medicaid programs were ordered by referring physicians who did not
receive P& H fees. The Court concludes that at least some of the claims HDL submitted to state
Medicaid programs were linked to tests ordered by physicians who received P&H fees from
HDL. 6 There is clearly a genuine dispute of material fact about how many of the claims
submitted to the state healthcare programs were tainted by the alleged kickback scheme, and this
question must be submitted to the jury. See U S. ex rel. Pogue v. Diabetes Treatment Centers of
Arn., 565 F. Supp. 2d 153, 161 (D.D.C. 2008) (denying summary judgment on claims arising out

of referrals by medical directors when relators did not provide those patients' Medicare forms
because ascertaining the number of false claims submitted and thus, the appropriate amount of
damages, is a question for the fact finder).

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Relators represented that the Colorado data would be made available to Defendants in July
2017.
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The parties do not appear to dispute that at least one or some of the relevant state claims are
linked to physicians who received P&H fees from HDL.

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C.

Conspiracy Claims

Relators have alleged and provided evidence to show that Mallory and her co-defendants
Dent and Johnson conceived and executed a marketing scheme to offer illegal P&H payments to
physicians who referred clients to HDL for testing. See, e.g., Dkt. No. 498-4 (HDL P&H
agreement); 504-6 (HDL position statement on P&H fees); 504-10 (Dent Dep. Tr.) at 14. This
evidence creates at least a genuine dispute of material fact about whether defendants ' marketing
scheme caused the submission of false claims and about whether Mallory is liable under a
conspiracy theory. A rational trier of fact could conclude that the evidence presented shows that
(1) Mallory willfully entered an agreement with Dent and Johnson with the goal of obtaining
reimbursement for false claims; (2) one conspirator performed an overt act to execute that
scheme; and (3) the state governments suffered damages when they reimbursed false claims.

D.

Claims Arising Under Insurance Statutes in California and Illinois

Mallory argues that Relators have submitted no evidence showing that HDL or Singulex
submitted (or were reimbursed for) claims to private insurers with clients in California or Illinois
in violation of either state ' s insurance statutes. Relators did not argue in their brief that they have
such evidence. (Dkt. No. 519.) For this reason, Relators have created no genuine dispute of
material fact about whether Mallory violated the insurance statues in Illinois or California, and
Mallory is entitled to summary judgment on these claims.

IV.

Advice of Counsel
Mallory has separately argued that she did not have the requisite scienter to violate any

state false claims act because the record shows that she consulted attorneys and asked for
guidance about the P&H practice. There is substantial evidence in the record that creates a

genuine dispute of material fact about whether Mallory had the requisite scienter to violate the

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state false claims acts. The court will discuss this issue in more depth in its order ruling on
Defendants ' motion for summary judgment on the Government' s FCA claims.
V.

Conclusion
For the reasons set forth above, Latonya Mallory's motion for summary judgment (Dkt.

No. 500) is granted with regard to Lutz and Webster' s claims arising under insurance statutes in
California and Illinois. Mallory' s motion for summary judgment is denied as to all other claims.
AND IT IS SO ORDERED.

United States District Court Judge
August ~' 2017

Charleston, South Carolina

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