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United States ex rel. Forcier v. Computer Scis. Corp.

United States District Court for the Southern District of New York

August 10, 2017, Decided; August 10, 2017, Filed

12 Civ. 1750 (DAB)

Opinion

MEMORANDUM AND ORDER

DEBORAH A. BATTS, United States District Judge.

In this qui tam action, Intervenors United States of America ("U.S." or the "Government") and the State of New York ("N.Y." or the "State") (collectively, "Intervenors") allege that Defendants the City of New York (the "City") and Computer Sciences Corporation ("CSC" or "Defendant") violated the federal False Claims Act ("FCA"), 31 U.S.C. §§ 3729 et seq., and the [*2]  New York False Claims Act ("NY FCA"), N.Y. Finance Law §§ 187 et seq., by submitting false claims to Medicaid for reimbursement. CSC has moved to dismiss the Government's First Amended Complaint—in—Intervention (the "U.S. FAC") and New York's First Amended Complaint—in—Intervention (the "N.Y. FAC"). For the reasons that follow, the Motion is DENIED in part and GRANTED in part.

I. Factual Background

For the purpose of this Motion, familiarity with the underlying facts is assumed, and the facts as alleged in Intervenors' Amended Complaints are assumed true.1 The facts are recited here only insofar as they are relevant to resolving the instant Motion.

1. Statutory and Regulatory Framework

The Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. §§ 1400 et seq., provides federal funding to states to "develop and implement a statewide . . . interagency system" to provide "early intervention services" for children under three years of age who are experiencing developmental delays or who have "a diagnosed physical or mental condition that has a high probability of resulting in developmental delay." Id. §§ 1431(b)(1), 1433(5)(A). Federal IDEA funding is available to states only to the extent that the costs of evaluation and care for eligible children [*3]  are not paid for by other sources, including private insurance and Medicaid. Id. § 1440.

In accordance with the IDEA, New York State created the Early Intervention Program ("EIP") to provide services to eligible children.2 N.Y. Pub. Health L. ("PHL") §§ 2540-2544. The EIP provides for municipalities, including the City, to pay service providers directly for EIP services rendered to children, and assume responsibility for seeking reimbursement.3 (U.S. FAC ¶¶ 27-29.) Under State EIP regulations, municipalities seeking reimbursement must, "in the first instance and where applicable, seek payment from private third party insurers, prior to claiming payment from Medicaid or the Department of Health, for services delivered to eligible children and their families." 10 N.Y.C.R.R. § 69-4.22(a). The costs not covered by private insurance or Medicaid are shared equally by the State and the City. PHL § 2557(2) ("[DOH] shall reimburse the approved costs paid by a municipality . . ., other than those reimbursable by [Medicaid] or by third party payors, in an amount of fifty percent of the amount expended.").

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2017 U.S. Dist. LEXIS 128140 *

United States of America ex rel. Vincent Forcier, Plaintiff, v. Computer Sciences Corporation and The City of New York, Defendants.

Prior History: United States ex rel. Forcier v. Computer Scis. Corp., 183 F. Supp. 3d 510, 2016 U.S. Dist. LEXIS 59907 (S.D.N.Y., Apr. 28, 2016)

CORE TERMS

regulations, provisions, billing, provider, collected, reimbursement, certification, third party, representations, false certificate, incentive payment, false claim, enrollment, private insurance, provide a service, fraudulent, quotation, coverage, marks, business agent, noncompliance, submitting, argues, fraudulent inducement, state regulation, fee schedule, municipality, half-truths, compliance, unrelated