Opinion ID: 2746816
Heading Depth: 2
Heading Rank: 2

Heading: Plaintiff Mastej

Text: Mastej has over 30 years of experience in the health care industry. Before he began working for Defendant HMA in 2001, Mastej held many positions in the health care industry. He worked as a Medicare/Medicaid auditor for Michigan Blue Cross, a reimbursement specialist with Humana, and as the CEO of several hospitals and medical centers. From 2001 to February 2007, he was Defendant HMA’s Vice President of Acquisitions and Development. In this role, Mastej attended monthly operations meetings with Defendant HMA’s CEO, Chief Operating Officer (“COO”), regional senior vice presidents, divisional vice presidents, and corporate department heads. While Vice President at HMA, Mastej “often attended weekly case management meetings in which Medicare and Medicaid patients and billing were discussed.” 3 Case: 13-11859 Date Filed: 10/30/2014 Page: 4 of 41 Mastej alleges that in these HMA weekly case management meetings, “every patient was reviewed, including how the services were being billed to each patient,” and as a result Mastej was “intimately familiar with the payor mix at the hospitals.”1 As HMA’s Vice President, Mastej was “specifically aware that the doctors and medical groups at issue in this case referred Medicare and Medicaid patients for service at Collier Boulevard and Pine Ridge” and “treated Medicare and Medicaid patients at those hospitals.” Additionally, Mastej flew on HMA’s corporate jets, making him familiar with the procedures for HMA’s use of its corporate jets. In February 2007, however, Mastej left Defendant HMA to work for its subsidiary, Defendant Naples HMA. From February 5, 2007 to October 2007, Mastej was the CEO of the Medical Center’s Collier Boulevard facility. Mastej’s responsibilities as Collier Boulevard’s CEO included “speaking to Defendants’ upper management on all aspects of management of Collier Boulevard.” 1 The parties’ briefs dispute whether paragraph 61 of the complaint alleges that Mastej attended these weekly case management meetings as Defendant HMA’s Vice President or as CEO of Collier Boulevard. The actual pleadings control this issue because the “weekly meetings” averment in paragraph 61 refers to only Mastej’s tenure as an HMA Vice President. We recognize that subsequent to the district court’s dismissal, Mastej filed a Rule 60(b) motion and an affidavit, where he attempted to clarify that he also attended these case management meetings while he was CEO of Collier Boulevard through October 2007. Because this was after the district court had dismissed his complaint, his actual complaint still controls. 4 Case: 13-11859 Date Filed: 10/30/2014 Page: 5 of 41 Additionally, Mastej negotiated many physician contracts for “on-call” coverage at Collier Boulevard. Through these two positions, Mastej “was familiar with the operational aspects pertinent to the fraudulent schemes in question.” And through these positions, “Mastej was familiar with the services offered by Collier Boulevard and Pine Ridge, the patient demand for [those] services, the staffing necessary to meet patient demand for [those] services, the revenues generated by [those] services, and the costs of providing [those] services.”