The opinion of the court was delivered by: Sue E. Myerscough, U.S. District Judge:
Wednesday, 03 October, 2012 05:37:18 PM
Clerk, U.S. District Court, ILCD
This matter is before the Court on the Amended Motion to Dismiss filed by Defendants Bharat K. Liliwani and Chicago Medi-Car Transit Corp. (CMCTC). See d/e 12. For the reasons that follow, Defendants' Amended Motion to Dismiss is denied.
In November 2006, Relator brought an action on behalf of the United States (Government) and the State of Illinois (State) against CMCTC and numerous other defendants alleging violations of the federal False Claims Act (FCA) (31 U.S.C. § 3729 et seq.) and what was at that time known as the Illinois Whistleblower Reward and Protection Act (Illinois Whistleblower Act) (740 ILCS 175/1 et seq.). The Illinois Whistleblower Act is now known as the Illinois False Claims Act (IFCA).
On March 24, 2010, after several extensions of time to consider whether to intervene, the Government filed The Government's Notice of Election to Intervene in Part and to Decline to Intervene in Part. The Government indicated its election to intervene as to several defendants, including CMCTC. The next day, the State filed its notice of intent to join the United States in intervening as to several defendants, including CMCTC.
On August 8, 2011, the Government and the State (collectively referred to as "Plaintiffs") filed a Complaint against CMCTC. See d/e 1.
The Complaint was a copy of the Relator's November 2006 complaint with the allegations relating to non-CMCTC defendants redacted. On November 10, 2011, Plaintiffs filed an Amended Complaint against Defendants. See d/e 2.
The Amended Complaint contains four counts. Count I is brought by the United States and alleges Defendants made false claims under the FCA, 31 U.S.C. § 3729(a). Count III is a claim brought by the State under the IFCA, 740 ILCS §§ 175/1-8. Counts II and IV are brought by both the United States and the State and allege unjust enrichment and payment under mistake of fact, respectively.
The Amended Complaint alleges that since at least November 7, 2000, Defendants knowingly participated in various schemes, artifices, and conspiracies to defraud and obtain money from Plaintiffs. Specifically, the Amended Complaint alleges that Defendants engaged in fraudulent schemes, which included: (1) the knowing submission of claims for services that had previously been submitted which resulted in duplicate payment to Defendants; (2) the knowing submission of claims for services not provided; and (3) the knowing submission of claims for services without a corresponding medical service.
The Amended Complaint describes each scheme. For example, with respect to the allegations that Defendants submitted false claims which resulted in duplicate payments to Defendants, the Amended Complaint alleges that the Illinois Department of Healthcare and Family Services (HFS) authorizes payment to transportation providers for qualified services that are actually provided. A provider may only be reimbursed one time for each service, and successive payments for the same service are not authorized. According to the Amended Complaint, Defendants knowingly presented multiple claims for the same purported transportation services without regard for whether HFS had already paid Defendants for that particular service.
The Amended Complaint provides an example of a duplicate claim where, on or about February 15, 2007, Defendants submitted a claim for transporting a Medicaid recipient, "C.H.," on February 14, 2007. Upon receiving the claims from Defendants, on July 5, 2007, HFS authorized payment to Defendants in the amount of $31.82, which represented a round trip paid at $15.91 each way. On or about March 22, 2007, while the first claim remained pending, Defendants submitted another claim for the same transportation of "C.H." HFS paid an additional $31.82 for the successive claim.
Plaintiffs attached "Attachment A," which lists the initials of each recipient; the date of service for each false, successive claim by Defendants; and a corresponding number for reference purposes. Attachment A purports to show the above information for 20,390 duplicate claims submitted by Defendants for which Defendants had already been paid by Medicaid.
As stated, the Amended Complaint also alleges that Defendants billed for services that were not actually provided. This category of allegations is ...