Opinion ID: 2786807
Heading Depth: 3
Heading Rank: 2

Heading: Counts VII and XIV

Text: For similar reasons, Counts VII and XIV of Relators' complaint also survive a motion to dismiss. The substance of those counts is that Arbour violated both the federal and Massachusetts FCA by fraudulently misrepresenting its compliance with regulations requiring mental-health clinics to employ at least one boardcertified psychiatrist at all times.15 See 130 Mass. Code Regs. 15 At different points in their complaint, Relators identify both MassHealth and Department of Public Health (DPH) regulations as the source of this staffing requirement. There is at least some ambiguity as to whether the MassHealth regulation in question, 130 Mass. Code Regs. § 429.422, independently requires each satellite clinic to employ its own psychiatrist. Section 429.422 provides that mental health centers must employ at least one psychiatrist. A mental health center is defined as an entity that delivers a comprehensive group of diagnostic and psychotherapeutic treatment services to mentally or emotionally disturbed persons and their families by an interdisciplinary team under the medical direction of a psychiatrist. 130 Mass. Code Regs. § 429.402. This definition appears to refer to an entity comprising both the parent center and the satellite locations. See 130 Mass. Code Regs. § 429.402 (defining parent center as the central location of the mental health center . . . .; defining autonomous satellite program and dependent satellite program as a mental health center program . . . .) (emphases added). On this reading of the definition of mental health center, a satellite that does not employ a psychiatrist is not out of compliance with the staffing regulation so long as the parent has a psychiatrist on staff. But the DPH regulations suggest something else. 105 Mass. Code Regs. § 140.530 provides that every clinic providing mental health services must employ a board-certified psychiatrist, or one who is eligible for board certification. A satellite clinic must meet [this requirement] independently of its parent clinic. 105 Mass. Code Regs. § 140.330. According to the DPH report attached -22- § 429.422(A); 105 Mass. Code Regs. § 140.530(C)(1)(a). Since the clinical director is explicitly responsible for hiring adequate psychiatric staff, see 130 Mass. Code Regs. § 429.423(B)(2)(e), and claims are reimbursable only if the clinical director fulfills the assigned duties, see id. § 429.439(C), Arbour's failure to maintain a properly licensed psychiatrist on staff constituted noncompliance with a material condition of payment. Such noncompliance was at least deliberately ignorant, in light of Relators' allegation that they were able to determine that Gaticales was not board-certified in psychiatry simply by checking a state licensing database. Thus, these counts, too, were improperly dismissed.16 to Relators' complaint, which details the results of the agency's investigation of the satellite clinic where Yarushka Rivera received treatment, that clinic was not in compliance with the staffing requirements of 105 Mass. Code Regs. § 140.530. We defer to the agency's determination that such regulation applies to the Arbour satellite clinic at issue here. See City of Pittsfield, Mass. v. U.S. Envt'l Prot. Agency, 614 F.3d 7, 10-11 (1st Cir. 2010) (giving controlling weight to agency's interpretation [of its own regulation] unless it is plainly erroneous or inconsistent with the regulation) (internal quotation marks omitted); Friends & Fishers of Edgartown Great Pond, Inc. v. Dep't of Envt'l Prot., 446 Mass. 830, 838 (2006) (deferring to agency's interpretation of its own regulations). 16 These counts also allege that Arbour violated core staffing requirements by failing to have at least one licensed psychologist on staff. However, the regulations do not mandate that a psychologist be on staff at all times; instead, clinics are required to employ at least two people from various disciplines, one of which is psychology. 130 Mass. Code Regs. § 429.422(A); 105 Mass. Code Regs. § 140.530(C)(2)(b). Although Fuchu held herself out as a licensed psychologist when she in fact was not, the complaint does not allege whether Arbour retained any other properly licensed psychologists, or staff in other approved disciplines. Thus, the portions of Counts VII -23-