UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE AT CHATTANOOGA

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1 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE AT CHATTANOOGA UNITED STATES OF AMERICA, ex rel. GLENDA MARTIN, Civil Action No. 1:08-CV-251 Plaintiffs, MATTICE/CARTER v. LIFE CARE CENTERS OF AMERICA, INC., Defendant. UNITED STATES OF AMERICA, ex rel. TAMMIE TAYLOR, Civil Action No. 1:12-CV-64 MATTICE/CARTER Plaintiffs, v. LIFE CARE CENTERS OF AMERICA, INC., Defendant. LIFE CARE S MOTION FOR PARTIAL SUMMARY JUDGMENT AS TO UNIDENTIFIED CLAIMS Defendant Life Care Centers of America, Inc. ( Life Care or Defendant, by and through undersigned counsel, hereby moves pursuant to Federal Rule of Civil Procedure 56(a for summary judgment on Counts I and II of the Government s Complaint as to all alleged false claims and false statements that the Government has not and has conceded it will not identify. In particular, the Government has represented to this Court and confirmed in discovery responses that it seeks to prove liability and damages against Life Care primarily based on a medical review of a sample of 400 patient medical records to determine the extent (if any to Case 1:08-cv HSM-WBC Document 140 Filed 02/18/14 Page 1 of 5 PageID #: 1385

2 which Life Care provided therapy services to federal beneficiaries that the Government will claim were not medically reasonable and necessary. The Government has retained a statistician 1 to use the results of the medical review of the 400 patient records, and to then extrapolate those results to a larger universe of 54,396 patient admissions, for which Life Care submitted 154,621 claims to the Government. This extrapolation analysis will estimate with undetermined imprecision only the number of claims that the Government characterizes as violations of the False Claims Act, but will not otherwise identify the patients, claim numbers, dates of service, types of therapy provided, identities of the physicians and therapy staff members who planned and/or provided the services, or any other information at the individual patient and claim level that will be sufficient to allow Life Care to know which particular claims and statements it must defend in this action (the Unidentified Claims. 2 This Motion is narrowly-tailored and seeks summary judgment only with respect to the Unidentified Claims for which the Government undisputedly will offer no individualized factual evidence. 1 Life Care has filed herewith a Motion to Exclude Expert Testimony of Constantin T. Yiannoutsos, Ph.D. (the Government s retained statistician based on the statistician s failure to satisfy the standards for admissibility of expert testimony pursuant to Fed. R. Evid. 702 due to deficiencies in the extrapolation methodology he proposes to use in this case. Although the subject matter of that motion and the instant motion overlap, they are separate. In other words, partial summary judgment may be granted without determining whether Dr. Yiannoutsos s proposed testimony satisfies Rule 702 and Daubert. Similarly, this motion may be granted without reaching the issue of whether statistical evidence can ever suffice for proof of falsity and causation under the False Claims Act 2 In addition to the claims for payment that Life Care submitted to Medicare and TRICARE and which the Government contends constituted violations of the False Claims Act, the Government alleges that Life Care used false records or statements (in the form of Minimum Data Set reports for each patient in support of each allegedly false claim, and separately pursues False Claims Act liability and damages for each such allegedly false record or statement. See Compl. 6, 160, For ease of reference, the term Unidentified Claims includes the allegedly false claims and records or statements that the Government does not identify. Case 1:08-cv HSM-WBC Document 140 Filed 02/18/14 Page 2 of 5 PageID #: 1386

3 Life Care is entitled to summary judgment on Counts I and II of the Government s Complaint with respect to the Unidentified Claims for the following reasons: 1. The False Claims Act places the burden of proof on the Government to establish all essential elements of each violation of the Act by a preponderance of the evidence, and the collective proof the Government intends to offer through its extrapolation methodology is insufficient to satisfy this burden with respect to each of the Unidentified Claims; 2. The Government cannot present evidence at the individual claim level that any of the Unidentified Claims was false for purposes of the False Claims Act a matter which is particularly significant in light of the highly subjective determinations inherent in making medical necessity determinations; 3. The Government cannot present evidence at the individual claim level that any person acted knowingly and with the scienter required by the False Claims Act for any of the Unidentified Claims; 4. The Government cannot present evidence at the individual claim level concerning the materiality of any of the Unidentified Claims; and 5. The Government s reliance on statistical sampling and extrapolation in lieu of claim-specific evidence violates Life Care s due process rights and improperly shifts the statutory burden of proof because it fails to apprise Life Care of the actual Unidentified Claims at issue, thus precluding Life Care from the opportunity to conduct a factual investigation and present factual and expert evidence to support its defenses relating to those Unidentified Claims. For the reasons set forth above and in the accompanying supporting Memorandum, Life Care respectfully requests that this Court grant its Motion for Partial Summary Judgment dismissing all of the Government s Unidentified Claims. Case 1:08-cv HSM-WBC Document 140 Filed 02/18/14 Page 3 of 5 PageID #: 1387

4 Dated: February 18, 2014 Respectfully submitted, MILLER & MARTIN PLLC By: /s/ Roger W. Dickson Roger W. Dickson, Tenn. Bar No Richard C. Rose, Tenn. Bar No Kyle W. Eiselstein, Tenn. Bar No Volunteer Building 832 Georgia Avenue Chattanooga, Tennessee Telephone ( Facsimile ( REED SMITH LLP Thomas C. Fox (admitted pro hac vice Scot T. Hasselman (admitted pro hac vice Eric L. Alexander (admitted pro hac vice Lawrence S. Sher (admitted pro hac vice Andrew C. Bernasconi (admitted pro hac vice 1301 K. Street, N.W., Suite 1100 East Tower Washington, D.C Tel: ( Fax: ( Attorneys for Defendant Life Care Centers Of America, Inc. Case 1:08-cv HSM-WBC Document 140 Filed 02/18/14 Page 4 of 5 PageID #: 1388

5 CERTIFICATE OF SERVICE I do hereby certify that the foregoing has been filed electronically. Notice of this filing will be sent by operation of the Court s electronic filing system to all parties indicated on the electronic filing receipt. All other parties will be served by regular U.S. Mail and/or facsimile or hand delivery. Parties may access this filing through the Court s electronic filing system. This 18th day of February, MILLER & MARTIN PLLC By: s/ Roger W. Dickson Case 1:08-cv HSM-WBC Document 140 Filed 02/18/14 Page 5 of 5 PageID #: 1389

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