PAUL A. CROTTY, District Judge:
Relators John and Jane Doe ("Relators") Bring This Action Against Defendants The Taconic Hills Central School District, The Auburn Enlarged City School District, The Mexico Central School District, The Greene Central School District (collectively, "Upstate Defendants"), and The New York City Department of Education ("DOE") (collectively, "Defendants") alleging that Defendants violated the False Claims Act (the "FCA"), 31 U.S.C. § 3729 et seq., by submitting fraudulent claims to Medicaid for case management services provided to disabled children when Defendants already received funding for those services under the Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. § 1400 et seq. Individually, the Upstate Defendants move to dismiss the Amended Complaint for improper venue and, alternatively, to transfer the cases to the Northern District of New York. The DOE moves to dismiss, in part, for failure to state a claim upon which relief may be granted.
The Upstate Defendants' motions are GRANTED and the DOE's motion is GRANTED. The claims against the Upstate Defendants are dismissed for improper venue, and the claims against the DOE for failure to state a claim. Since Relators fail to state a claim upon which relief may be granted against the DOE and their claims against the Upstate Defendants are almost identical, transferring the claims against the Upstate Defendants would not be in the interest of justice. Pursuant to 28 U.S.C. § 1406(a), the Court declines to transfer the claims against the Upstate Defendants to the Northern District of New York.
Congress enacted IDEA to ensure that "all children with disabilities have available to them a free and appropriate public education ["FAPE"] that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living." 20 U.S.C. § 1400(d)(1)(A); see N.Y. Educ. Law § 4402(2)(a). New York school districts work to fulfill the IDEA's mission by providing special education services to public school students. see N.Y. Educ. Law § 4402(2)(a).
The IDEA and state law require schools to develop Individualized Education Programs ("IEPs") for special-needs students. See 34 C.F.R. § 300.320; N.Y. Educ. Law § 4402(3); 8 N.Y.C.R.R. § 200.4(b). Developed during meetings of the Committee on Special Education ("CSE"), IEPs are written plans detailing the programs and services to "be provided to enable the child [t]o advance appropriately toward attaining the annual goals" for academic achievement and functional performance. 34 C.F.R. § 300.320(a)(4)(i); see 8 N.Y.C.R.R. § 200.4(b). The development of an IEP is based on information provided by parents, school district representatives, and teachers, evaluations conducted by healthcare professionals, and a review of school records and tests. See N.Y. Educ. Law § 4402(3); 8 N.Y.C.R.R. § 200.4(b).
For services rendered prior to July 1, 2010, New York State school districts receive federal funding for special education programs in two ways. First, New York State agencies receive federal grants under the IDEA, see 20 U.S.C. § 1411(a)(1); 34 C.F.R. § 300.700(a); see also Declaration of Robert W. Sadowski ("Sadowski Decl."), ECF No. 72, Ex. B, and distribute the funds to public school districts for development of special education services, see 20 U.S.C. § 1411(f)(1); 34 C.F.R. § 300.202(a). In order to receive these funds, school districts submit applications to the New York State Education Department ("SED"). A school district can use IDEA funds for "related case management activities of teachers and related services personnel providing services described in the IEP of children with disabilities, that is needed for the implementation of those case management activities." 34 C.F.R. § 300.208(b). For example, SED's application lists expenditures related to IEP meetings and IEP team coordinator costs as allowable uses of IDEA funding. See Sadowski Decl., Ex. C at 19, 21.
Second, Title XIX of the Social Security Act (the "Medicaid Act"), 42 U.S.C. § 1396 et seq., provides federal funds to participating states for Targeted Case Management ("TCM") services furnished to Medicaid-eligible disabled school children. See id. § 1396b(c). The Centers for Medicare & Medicaid Services ("CMS"), a federal agency within the U.S. Department of Health and Human Services, administers the Medicaid program in partnership with state agencies. On January 21, 1988, CMS approved the New York State Plan Amendment (SPA) No. 96-41, see Declaration of Christopher P. Langlois ("Langlois Decl."), ECF No. 44, Ex. C, which created the School Supportive Health Services Program ("SSHSP") and went into effect on October 3, 1996. The New York Department of Health ("DOH") and SED jointly administer SSHSP to assist New York State school districts in obtaining Medicaid reimbursement for TCM services.
On July 30, 2009, SED issued a Medicaid in Education Alert to all SSHSP Medicaid providers. See id., Ex. J. According to the release, pursuant to a settlement the State reached with the Federal government concerning audits of SSHSP programs in certain districts, schools would no longer be allowed to submit claims for TCM services with a service date of July 1, 2009, or later. Pursuant to New York State Plan Amendment (SPA) No. 10-35, billing for TCM services was terminated on July 1, 2010 and New York State Plan Amendment (SPA) No. 96-41 was rescinded. See id., Exs. K & L. Schools were permitted to bill for services provided prior to July 1, 2010, however, despite the 2009 moratorium on billing. See id., Ex. L. The State subsequently altered the types of TCM services eligible for Medicaid reimbursement. See generally id., Ex. M.
Relators are the parents of one of the school-aged children with disabilities who became aware of Defendants' Medicaid billing. See Amended Complaint ("Am. Compl.") ¶ 10. ECF No. 9. Relators allege that Defendants submitted false and fraudulent claims to Medicaid for TCM services that were not rendered. Id. ¶ 3. Specifically, Relators identify sixteen children who received special education pursuant to an IEP at one of the defendant schools from 2000 to 2010 ("Child A-P"). Id. ¶¶ 66-238. For Child A-P, Relators claim that Defendants failed to do at least one of the following: (1) provide TCM services beyond the development and implementation of the IEP, (2) assign a case manager to each child for whom the DOE billed Medicaid, (3) hold an IEP meeting thirty days before billing Medicaid for TCM services, (4) notify parents that TCM services were to be provided to their children, and (5) obtain parental consent to bill Medicaid for TCM services. Id. ¶ 63. Defendants either used software programs, like Clear-Track 200, to automatically bill Medicaid for TCM services, id. ¶¶ 54-61, or manually billed for TCM services that were not provided, id. ¶ 62. As a result, Relators allege that Defendants violated the FCA in the following three ways: (a) by presenting false claims (31 U.S.C. § 3729(a)(1)(A)), (b) by using false statements in connection with a claim (31 U.S.C. § 3729(a)(1)(B)), and (c) by presenting
Relators' opposition to Defendants' motions to dismiss, however, presents a more nuanced theory of liability. Relators now claim that TCM services "that would have been reimbursable to Medicaid are those that would supplement the services already paid for by IDEA such as, accessing other medical service, financial service, social assistance and the like." See Relators' Opposition to Motions to Dismiss ("Relators' Opp'n"), ECF No. 73, 6 n. 1 (citing Am. Compl. ¶¶ 27, 40-47). According to Relators, Defendants did not provide any of these services; rather, they billed Medicaid for IDEA services that were already funded by IDEA grants. Such duplicative billing, the argument goes, violates the FCA because multiple federal statutes and regulations prohibit a school from billing Medicaid for services that already received other federal funding. Under either theory, the case largely depends on whether school districts were permitted to seek Medicaid reimbursement for IEP reviews — without providing additional services — under federal and state Medicaid laws.
Defendants are improperly joined in this action and therefore all claims must be severed. Under Federal Rule of Civil Procedure 20(a)(2), joinder of multiple defendants is proper only if:
Relators must demonstrate both. See Deskovic v. City of Peekskill, 673 F.Supp.2d 154, 159 (S.D.N.Y.2009). Here, there are no allegations suggesting that Defendants can be held jointly or severally liable for any allegedly false claim made by any other Defendant. Further, Relators do not assert a right to relief against the Defendants arising out of the "same transaction, occurrence, or series of transactions or occurrences." Relators simply allege that each Defendant submitted its own Medicaid bills for services provided to its own students. Joinder is improper where, as here, "the plaintiff does no more than assert that the defendants merely committed the same type of violation in the same way." Peterson v. Regina, 935 F.Supp.2d 628, 638 (S.D.N.Y.2013) (internal quotations omitted).
Once the claims are severed, Relators cannot establish that venue is proper for the Upstate Defendants. According to 28 U.S.C. § 1391(b)(2), a civil action may be brought in a district "in which a substantial part of the events or omissions
Accordingly, the Court severs the claims against each Defendant and holds that venue is improper for Relators' claims against the Upstate Defendants. The Court must then determine whether transferring the claims to the Northern District of New York would be in the "interest of justice." See 28 U.S.C. § 1406(a). Since Relators fail to state a claim upon which relief may be granted against the DOE, see infra Part II, and their claims against the Upstate Defendants are almost identical, transferring would not be in the interest of justice. Pursuant to Federal Rule of Civil Procedure 12(b)(3), the Court therefore dismisses the claims against the Upstate Defendants for improper venue without prejudice.
To state a claim for relief, "a plaintiff must provide the grounds upon which his claim rests through factual allegations sufficient `to raise a right to relief above the speculative level.'" ATSI Commc'ns, Inc. v. Shaar Fund, Ltd., 493 F.3d 87, 98 (2d Cir.2007) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). Plaintiff must allege "`enough facts to state a claim to relief that is plausible on its face.'" Starr v. Sony BMG Music Entm't, 592 F.3d 314, 321 (2d Cir.2010) (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955). "A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). The Court accepts as true all well-pleaded factual allegations and draws all inferences in Plaintiff's favor. See Allaire Corp. v. Okumus, 433 F.3d 248, 249-50 (2d Cir.2006). When a plaintiff alleges fraud, however, those allegations must meet the higher pleading standard set forth in Federal Rule of Civil Procedure 9(b). Under
Relators allege three causes of action. The § 3729(a)(1)(A) claim must allege facts showing that the defendant "(1) made a claim, (2) to the United States government, (3) that is false or fraudulent, (4) knowing of its falsity, and (5) seeking payment from the federal treasury." United States ex rel. Mikes v. Straus, 274 F.3d 687, 695 (2d Cir.2001). The § 3729(a)(1)(B) claim must allege that the defendant "(1) created, used, or caused to be used, a record or statement; (2) that is false or fraudulent, (3) knowing of its falsity, (4) to get a false or fraudulent claim paid or approved by the government." United States ex rel. Taylor v. Gabelli, 345 F.Supp.2d 313, 327 (S.D.N.Y.2004). Finally, the § 3729(a)(1)(G) claim must allege that the defendant "(1) made a false statement or created and used a false record, (2) with knowledge of its falsity, (3) for the purpose of decreasing, concealing, or avoiding an obligation to pay the Government." Id. Thus, for each claim, Relators must allege that the DOE made a false claim or statement to the government and that the DOE knew that it was false.
"A claim is `false or fraudulent' if it `is aimed at extracting money the government otherwise would not have paid.'" United States ex rel. Colucci v. Beth Israel Med. Ctr., 785 F.Supp.2d 303, 310 (S.D.N.Y.2011) (quoting Mikes, 274 F.3d at 696). Relators allege that the DOE submitted both "factually false" and "legally false" claims. A claim is "factually false" if it "involves an incorrect description of goods or services provided or a request for reimbursement for goods or services never provided." Mikes, 274 F.3d at 697. A claim is "legally false" if it rests on a false representation of compliance with an applicable federal statute, regulation, or contractual term. Id. at 696. Known as the "legally false certification theory," these certifications can be either express or implied. Id. at 698-99. "An expressly false claim is, as the term suggests, a claim that falsely certifies compliance with a particular statute, regulation or contractual term," whereas "[a]n implied false certification claim is based on the notion that the act of submitting a claim for reimbursement itself implies compliance with governing federal rules that are a precondition to payment." Id.
Relators' primary argument is that the DOE submitted factually false claims because it billed Medicaid for TCM services that were never provided. See Am. Compl. ¶ 3. According to Relators, federal and state regulations prohibit billing Medicaid for the same services that a school received federal funding for under the IDEA. As a result, the argument goes that school districts may only bill Medicaid for services beyond development and implementation of an IEP. Because the DOE did not provide any additional services, Relators allege that the DOE submitted false claims for Medicaid reimbursement. But Relators misconstrue the applicable legal framework in place during the time period in question.
Federal Medicaid regulations set requirements that a State Medicaid plan must meet to qualify for federal funding. See, e.g., 42 U.S.C. 1396a(a) ("A state plan for medical assistance must. . . ."); id.
Here, the Federal government approved New York State's Medicaid program prior to its enactment. See Langlois Decl., Ex. C. (approving SPA No. 96-41, which defined the types of reviews that would be reimbursable under the State Medicaid program). It was then up to the DOH and SED to determine the standards and procedures for claims submission in accordance with those terms. That is exactly what the State did in establishing rate codes for the following IEP services: an initial review, an annual review, an amended/requested review, and a triennial/re-evaluation review. See Langlois Decl., Ex. E at 29; see also id., Ex. D at 19.
Relators respond that even if the State permitted this, "New York State guidance cannot and does not contradict federal and state laws that prohibit duplicative billing." See Relators' Opp'n at 3. But any conflict between federal and state Medicaid regulations is the fault of New York State, which set up these billing procedures. It is not the fault of school districts like the DOE, which acted in accordance with these billing procedures as required by state law. The appropriate remedy here would be for the Federal government to withhold Medicaid funding from New York State. Indeed, the Federal government did this on July 30, 2009 when it reached a settlement with New York State that prohibited school districts from billing Medicaid for TCM services until the State adopted new billing procedures. See id., Ex. J. But it is not appropriate to hold the DOE liable for submitting a "false claim" when it complied with all applicable regulations and therefore did absolutely nothing wrong.
Relators also point to broad prohibitions on duplicative billing in state regulations and the SSHSP Handbook. See Relators' Opp'n at 15-16. But these prohibitions merely reinforce Medicaid's general status as a payor of last resort. See Langlois Decl., Ex. D at F-1; id., Ex. E at F-1; see also 18 N.Y.C.R.R. § 505.16(b)(2). According to the Government, Medicaid's status as a payor of last resort has no bearing on whether the DOE made a false claim with respect to educationally-related services. See Letter from Assistant U.S. Attorney Sarah S. Normand to the Honorable Paul A. Crotty at 3, March 14, 2014, ECF No. 87. Title XIX of the Social Security Act warns that nothing in its subchapter should be "construed as prohibiting or restricting . . . payment . . . for medical assistance for covered services furnished to a child with a disability because such services are included in the child's individualized education program." Id. at 2 (quoting 42 U.S.C. § 1396b(c)). The Government concludes that "consistent with IDEA and Title XIX of the Social Security Act, a school district may seek reimbursement from Medicaid to pay for [covered] services necessary to ensure the provision of [free appropriate public education] to Medicaid-eligible children with disabilities." Id. at 3. For services eligible for reimbursement, "Medicaid reimbursement is not precluded because the school district may also receive IDEA grant funds or because the school district has an independent obligation to ensure the provision of [the IDEA] to children with disabilities." Id.
In response, Relators shift gears and now claim that "it is not the fact that Medicaid is generally a payor of last resort that rendered Defendants' acts unlawful, but that Defendants were double-billing." See Letter from Robert W. Sadowski to the Hon. Paul A. Crotty, March 20, 2014 at 1-2, ECF No. 89. But, even if the DOE was prohibited from billing Medicaid for services covered by IDEA funding, Relators still fail to allege that the DOE received any duplicative funds. The Amended Complaint merely alleges that "the Federal government provides a block grant to fund the development and implementation of IEPs . . . for school-aged children with disabilities." Am. Compl. ¶ 12. It does not allege, however, that IDEA funding covered the IEP reviews for Child C-L's IEP reviews in full. In fact, the Amended Complaint does not even suggest that the DOE received any IDEA funding or applied it to students' IEP reviews. This is likely because any IDEA funding the DOE receives cannot cover the full scope of IEP services provided to its students. See 20 U.S.C.
Relators appear to rely on a legally false certification theory in pleading the remaining allegations. Relators allege that the DOE failed to meet the following programmatic state and federal requirements: (1) assign a case manager to each child for whom DOE billed Medicaid, (2) hold an IEP meeting thirty days before billing Medicaid for TCM services, (3) notify parents that TCM services were to be provided to their children, or (4) obtain parental consent to bill Medicaid for TCM services. Since the DOE certified that its TCM services were provided in compliance with "applicable federal and state laws and regulations," see Am. Compl. ¶ 14, the argument goes that the DOE submitted a legally false certification. The question then becomes whether Relators allege that the DOE submitted an express or an implied false certification claim. Because an express certification "cannot be premised on anything as broad and vague as a certification that there has been compliance with all `federal, state and local statutes, regulations, [and] policies,'" the Court must apply the implied certification theory. See United States ex rel. Feldman v. City of New York, 808 F.Supp.2d 641, 652 (S.D.N.Y.2011).
As a preliminary matter, Relators cannot maintain a cause of action based on the first (assigning a case manager) and second allegations (holding an IEP meeting 30 days prior to billing). First, the DOE was not required to assign a case manager to each child for whom it billed Medicaid. The SSHSP Handbook makes clear that a "service coordinator or CSE, with the student's parent or other responsible individual," may perform the initial, amended/requested, annual, and re-evaluation/triennial reviews. See Langlois Decl., Ex. E at 30; id., Ex. D at 20-21. It is only when a school district bills for ongoing service coordination—a service not reimbursable to the DOE—that "[a] service coordinator must be assigned to the student." Id., Ex. E at 32; id., Ex. D at 22. Second, Relators allege that the DOE "failed to hold an IEP meeting thirty days prior to billing Medicaid for TCM services." Am. Compl. ¶ 63. But Relators fail to cite to any applicable regulation or statute.
Relators' remaining allegations regarding parental notification and consent
Relators also fail to allege that the DOE knowingly submitted false or fraudulent claims. To establish a violation of the FCA, a plaintiff must establish that the defendant acted "knowingly" in presenting or causing to present a false claim for payment, or making or using a false record, or to avoid an obligation to pay. See 31 U.S.C. § 3729(a)(1)(A), (a)(1)(B), & (a)(1)(G). The FCA defines "knowing" and "knowingly" to "mean that a person, with respect to information—(i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information." Id. § 3729(b)(1). Even assuming federal law prohibited the DOE from billing Medicaid for the development and implementation of IEP reviews, it did so under the exact procedures set up by the State. Indeed, the DOE, as a creation of state law and a grant recipient, was obligated to follow those procedures. See, e.g., 18 N.Y.C.R.R. § 504.3(f) ("By enrolling the provider agrees . . . to submit claims . . . in the manner specified by the department in conformance with the standards and procedures for claims submission. . . ."). As a result, it would have been impossible for the DOE to know that billing Medicaid—using rate codes provided by the State and approved by the Federal government—violated federal law. See Colucci, 785 F.Supp.2d at 316 ("Even assuming the claims submitted by [defendant] were `false,' given the lack of clarity in the law, it cannot be said that defendants `knew' the claims were false.").
Furthermore, the alleged facts are insufficient to give rise to a plausible inference that the DOE knowingly submitted false claims. On the basis of "information and belief," Relators merely allege that the DOE "automatically billed for TCM services without checking to ensure that those services were provided," Am. Compl. ¶ 62, and did "not manually revers[e] a TCM
Accordingly, the Court severs the claims against each Defendant and dismisses the claims against the Upstate Defendants without prejudice for improper venue. Transfer of these claims to the Northern District of New York is not warranted under 28 U.S.C. § 1406(a) and therefore the Court declines to do so. Pursuant to Federal Rule of Civil Procedure 12(b)(6), the Court also dismisses he claims against the DOE without prejudice. The Upstate Defendants' motion is GRANTED and the DOE's motion is GRANTED. The Clerk of the Court is directed to enter judgment and to terminate this case.