United States v. John Muir Health — June 2016 (Summary)

WRONGFUL DISCHARGE; WHISTLEBLOWER; FALSE CLAIMS ACT

United States v. John Muir Health
Case No. 13-cv-01924-SI (N.D. Cal. June 29, 2016)

The United States District Court for the Northern District of California granted in part and denied in part a hospital’s motions for summary judgment concerning a former hospital employee who claimed that the hospital retaliated against her through wrongful termination. The former hospital employee allegedly had a history of poor communication skills. In discussing her performance concerns, the Executive Director of her department noted that if her communication and leadership skills did not improve, she risked termination. Despite these concerns, the former employee later received positive performance reviews and was promoted.

In accordance with her duties, the former employee attended a conference on Medicare billing procedures and physician supervision requirements.  She was notified that in order for Medicare reimbursements to be billed, physicians had to be present to supervise procedures. After the conference, the former employee discussed the supervision requirements with the hospital’s physicians and expressed concern that there was not always direct supervision at the hospital, which then created concerns of false claims to the government.  The former employee alleged that the physicians disputed their requirements and became hostile, claiming that they could do what they want. A physician then expressed concern that the former employee would report them to CMS. The former employee was later terminated due to what the hospital characterized as “job restructuring” that eliminated her position.

On the primary summary judgment claim, the hospital was denied summary judgment because the court ruled that there was a genuine issue of material fact as to why the former employee was terminated. The former employee claimed the hospital retaliated against her via termination because she was trying to stop the hospital from submitting false claims for payment.  The hospital claims the former employee was terminated because of her well-documented history of poor communication skills that made her hard to work with. Though the hospital presented evidence of a non-retaliatory motive for firing the former employee, the former employee presented evidence of positive performance reviews up until 10 days before her termination and questionable e-mails sent by the director of her department following her termination. Her evidence created a genuine issue of material fact concerning why she was fired and prevented summary judgment.