United States District Court, S.D. Georgia, Statesboro Division
UNITED STATES OF AMERICA and THE STATE OF GEORGIA ex rel. PHIL FLEXON, Plaintiffs,
MEADOWS REGIONAL MEDICAL CENTER, INC. and WAYNE WILLIAMS, M.D., Defendants.
RANDAL HALL, CHIF JUDGE UNITED STATES DISTRICT COURT.
qui tarn action, Relator Phil Flexon alleges that Defendants
billed the government for services Defendants did not provide
and for services that were not medically necessary and that
Defendant Meadows Regional Medical Center fired Relator in
retaliation for his reporting Defendants' fraudulent
conduct. Defendants move to dismiss Relator's claims,
arguing (1) that Relator has not sufficiently alleged that
Defendants submitted false claims to the government and (2)
that there is no causal connection between the termination of
Relator's employment and his reporting Defendants'
alleged misconduct. The Court, however, is satisfied that
Relator has adequately pleaded that Defendants submitted
false claims to the government. And when the complaint is
viewed in the light most favorable to Relator, he has
plausibly alleged a causal connection between his reporting
Defendants' actions and the termination of his
employment. Accordingly, the Court DENIES
Defendants' motion to dismiss (doc. 26).
case arises out of Relator's employment with Meadows
Regional. Relator joined the staff at Meadows Regional in
2011. (Doc. 24 ¶ 84.) Defendant Dr. Wayne Williams, an
ear-nose-and-throat specialist, was also employed by Meadows
Regional during Relator's tenure there. (Id.
ear-nose-and-throat specialist, Dr. Williams routinely
operates on patients' sinuses. (Id. ¶ 52.)
But according to Relator, Dr. Williams's surgeries are
often a fraud. More specifically, Relator contends that Dr.
Williams regularly fails to fully perform surgeries and
performs surgeries that are not medically necessary. Relator
alleges, for example, that J.H., a patient of Dr. Williams,
needed extensive surgery in 2010. (IdL ¶ 77.) Although
Dr. Williams operated on J.H., Relator contends, he did not
perform the surgery he claimed to have performed.
(Id. ¶ 77.) Relator also alleges, as another
example, that Dr. Williams performed procedures on another
patient, N.G., that were not medically
necessary. (Id. ¶ 79.) Relator alleges,
moreover, that Defendants submitted claims for payment for
these surgeries to the government. (Id. ¶¶
77, 79, 81.) Relator uncovered Dr. Williams's fraudulent
practices when he operated on two of Dr. Williams's
former patients. (Id. ¶¶ 87-88.) Relator
apprised Meadows Regional of his discovery, and he claims
that Meadows Regional fired him in retaliation for reporting
his findings. (Id. ¶¶ 88, 91-92.)
filed a sealed complaint in this Court in April 2015,
alleging violations of the False Claims Act, 30 U.S.C. §
3729 et seq., and the Georgia Medicaid False Claims
Act, O.C.G.A. § 49-4-168 et seq. (Doc. 1.)
After investigating, the government declined to intervene,
and the Court unsealed Relator's complaint and ordered it
served on Defendants in September 2016. (Docs. 11, 12.)
Defendants moved to dismiss Relator's complaint, and in
response, Relator moved for leave to amend. (Docs. 17, 19.)
Defendants consented and the Court granted Relator leave to
file an amended complaint. (Doc. 23.) Defendants now move to
dismiss Relator's claims. (Doc. 26.)
considering a motion to dismiss under Rule 12(b)(6), the
Court tests the legal sufficiency of the complaint.
Scheuer v. Rhodes, 416 U.S. 232, 236 (1974). The
Court must accept as true all facts alleged in the complaint
and construe all reasonable inferences in the light most
favorable to the plaintiff. See Hoffman-Pugh v.
Ramsey, 312 F.3d 1222, 1225 (11th Cir. 2002). The Court,
however, need not accept legal conclusions as true, only
well-pleaded facts. Ashcroft v. Iqbal, 556 U.S. 662,
complaint also must "'contain sufficient factual
matter, accepted as true, *to state a claim to relief that is
plausible on its face.'" Id. at 678 (citing
Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570
(2007)). The plaintiff is required to plead "factual
content that allows the court to draw the reasonable
inference that the defendant is liable for the misconduct
alleged." Id. "The plausibility standard
is not akin to a 'probability requirement, ' but it
asks for more than a sheer possibility that a defendant has
acted unlawfully." Id.
Rule 9(b), a plaintiff alleging fraud "must state with
particularity the circumstances constituting fraud . . .
." Fed.R.Civ.P. 9(b). The purpose of this rule is to
alert "defendants to the precise misconduct with which
they are charged . . . ." Ziemba v. Cascade
Int'l, Inc., 256 F.3d 1194, 1202 (11th Cir. 2001)
(citation omitted) (internal quotation marks omitted). And it
requires a plaintiff to allege details of the defendant's
"allegedly fraudulent acts, when they occurred, and who
engaged in them." Cooper v. Blue Cross & Blue
Shield of Fla., Inc., 19 F.3d 562, 568 (11th Cir. 1994)
asserts claims under 31 U.S.C. §§
and 3730(h). More specifically, Relator contends that
Defendants billed the government for services that Dr.
Williams did not perform and for services that were not
medically necessary in violation of § 3729. And he
argues that Meadows Regional violated § 3730(h) because
it terminated his employment in retaliation for his reporting
the fraudulent practices. Defendants move to dismiss
Relator's claims, arguing that he has failed to plead
sufficient facts to support his claims.