Opinion ID: 3051534
Heading Depth: 3
Heading Rank: 1

Heading: FCA and CFCA Retaliation Claims

Text: [6] As noted, Mendiondo’s claims for retaliation under the FCA and CFCA must allege that (1) she was engaged in protected conduct; (2) CHMC knew she engaged in such conduct; and (3) CHMC retaliated against her because of the conduct. See Moore, 275 F.3d at 845; Hopper, 91 F.3d at 1269. 3354 MENDIONDO v. CENTINELA HOSPITAL [7] For purposes of the first element, Mendiondo engaged in protected activity if she reasonably believed that CHMC was possibly committing fraud against the government, and she investigated the possible fraud. See Moore, 275 F.3d at 845; Hopper, 91 F.3d at 1269. Mendiondo alleges that she investigated “facts relating to Tenet and CHMC’s submission of false claims and false records to the government.” The complaint contains examples of practices at CHMC that Mendiondo and her co-plaintiffs suspected to be fraudulent attempts to inflate Medicare reimbursements: one doctor allegedly performed numerous unnecessary catheterizations; CHMC implanted single ventricular pacemakers, even when patients needed biventricular pacemakers; and CHMC kept patients on observation status or as inpatients, without regard to medical need and in violation of Medicare reimbursement guidelines. Mendiondo also alleges that CHMC obtained reimbursement for more radiologic and catheterization procedures than were actually performed by having billing personnel manually change the billing records. Although far from a model of clarity, Mendiondo’s allegations provide CHMC with notice of the potentially fraudulent practices that Mendiondo believes led to false claims. [8] For the second element of her FCA and CFCA retaliation claims, Mendiondo alleges she complained to CHMC’s CEO, Harry Koening, about possible “civil and criminal violations.” Although vague, the reference to “civil violations” can be construed to include the suspected Medicare fraud described above. Because Mendiondo complained to Koening about the suspected civil violations, CHMC was informed of Mendiondo’s protected activity. [9] Finally, for the third element of her FCA and CFCA retaliation claims, Mendiondo alleges that CHMC terminated her “because of her investigation into facts relating to Tenet and CHMC’s submission of false claims and false records to the government.” It suffices at this pleading stage for Mendiondo to simply give notice that she believes CHMC termiMENDIONDO v. CENTINELA HOSPITAL 3355 nated her because of her investigation into the practices she specified in the complaint. See Edwards, 356 F.3d at 1061 (noting that discovery is “often necessary to uncover a trail of evidence regarding the defendants’ intent in undertaking allegedly discriminatory action”). [10] Although the complaint may be inartfully drawn, it nonetheless contains sufficient facts under the applicable notice pleading standards of 8(a) to survive dismissal under Rule 12(b)(6). 2. Claim for Retaliation in Violation of California Health and Safety Code Section 1278.5 Section 1278.5 of the California Health and Safety Code is intended to encourage medical staff and patients to notify government entities of “suspected unsafe patient care and conditions.” Cal. Health & Safety Code § 1278.5(a). The statute prohibits retaliation against any employee who complains to an employer or a government agency about unsafe patient care or conditions. Id. § 1278.5(b)(1)(A), (g). [11] In the complaint, Mendiondo identifies practices that allegedly compromised patient care, including unnecessary catheterizations, implanting single instead of biventricular pacemakers, refusing to use the safest drug for heart attacks because of cost reasons, and using outdated cardiac equipment. Mendiondo alleges she complained to CHMC’s CEO and her supervisor about substandard patient care. Finally, Mendiondo alleges that CHMC terminated her “because she demanded that minimum state and federal standards of health care be maintained.” The allegations contain sufficient facts under Rule 8(a) to survive dismissal under Rule 12(b)(6). 3356 MENDIONDO v. CENTINELA HOSPITAL 3. Wrongful Termination in Violation of Public Policy [12] To establish her claim for wrongful termination in violation of the public policies embodied in the FCA, CFCA, and California Health and Safety Code Section 1278.5, Mendiondo must allege facts similar to her retaliation claims: that she was terminated based on her complaints about potentially false billing practices and/or substandard patient care. See Haney v. Aramark Unif. Serv., Inc., 17 Cal. Rptr. 3d 336, 34849 (Cal. Ct. App. 2004). As detailed above, Mendiondo alleged sufficient facts to support her retaliation claims. The same allegations support her claim for wrongful termination in violation of public policy. Accordingly, her claim should not have been dismissed.4