The Southern District Court of Mississippi granted hospice provider SouthernCare Inc.’s motion to dismiss a whistleblower’s False Claims Act complaint. However, the court will proceed in hearing allegations that the company terminated an employee who raised concerns about these practices.
Former SouthernCare nurse Rhonda McClinton filed a qui tam complaint against the organization in 2016, alleging that the hospice provider submitted hospice claims to Medicare for patients who were not eligible and billed for services it did not provide. She also claimed that she was fired after confronting superiors about these accusations.
Qui tam cases occur when a whistleblower, deemed a “relator” by courts, files a False Claims Act (FCA) suit in concert with the government. The relator can potentially receive a portion of any funds recovered by the government via the lawsuit, typically ranging from 15% to 25%.
The court granted SouthernCare’s motion on procedural and jurisdictional grounds.
“Having found that this Court lacks jurisdiction over the relator’s presentment claim per the first to file bar, the Court declines to consider the remainder of SouthernCare’s arguments,” Reeves ruled. “The Court, however, retains jurisdiction over the relator’s FCA retaliation claim, which may proceed.”
A key issue in the motion was the “first to file” rule, which in layman’s terms means that a relator cannot file suit to resolve allegations that have already been made in a separate complaint.
Prior to McClinton’s allegations, SouthernCare was already embroiled in a similar suit heard in a federal court in Pennsylvania. The company settled that first suit in 2018 for nearly $6 million. The relators in that case, Dawn Hamrock and Patricia Beegle, shared approximately $1.1 million of the recovery.
Though McClinton filed an amended complaint in September 2021, Reeves found that the revised complaint still did not meet the first to file rule.
“A relator cannot avoid the bar by ‘simply adding factual details or geographic locations to the essential or material elements of a fraud claim against the same defendant described in a prior complaint,’” Reeves ruled.
Southerncare is a subsidiary of hospice provider Curo Health Services. Humana Inc. (NYSE: HUM) and private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe acquired Curo in July 2018 for $1.4 billion. Curo had purchased Southerncare in 2014 for an undisclosed amount. Most of the alleged fraudulent activity in the 2018 and 2009 cases occurred prior to Curo’s ownership.
Companies featured in this article:
Curo Health Services, Humana, SouthernCare, TPG Capital, Welsh Carson Anderson & Stowe
