United States District Court, W.D. Washington, Tacoma
ORDER DENYING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT
BENJAMIN H. SETTLE, District Judge.
This matter comes before the Court on Defendant Harrison Medical Center's ("Harrison") motion for summary judgment (Dkt. 22). The Court has considered the pleadings filed in support of and in opposition to the motion and the remainder of the file and hereby denies the motion for the reasons stated herein.
I. PROCEDURAL HISTORY
On November 14, 2013, Plaintiff Lori Cook ("Cook") filed a complaint against Harrison alleging (1) wrongful retaliatory termination in violation of Washington law, federal law, and the False Claims Act, 31 U.S.C. 3730(h) ("FCA") and (2) a claim for unpaid and willfully withheld wages. Dkt. 1.
On December 14, 2014, Harrison filed a motion for summary judgment. Dkt. 22. On December 19, 2014, Cook responded. Dkt. 24. Harrison did not reply.
II. FACTUAL BACKGROUND
Cook declares that she has approximately 37 years of medical accounts receivable experience. Dkt. 25-1, Declaration of Lori Cook ("Cook Dec."), ¶ 2. This experience includes "28 years physician billing, 20 years hospital billing (some years of hospital and physician claims overlap and done concurrently), 2 years long term care billing, and 7 years home health billing." Id. In April 2011, Cook began employment at Harrison as the Billing Manager for Harrison Home Health, a service of Harrison. Id. ¶ 3. Harrison used McKesson Horizon Homecare Software to prepare its Medicare billings. Id.
In July 2011, Diane Wasson became Harrison's Home Health Director. Id., ¶ 6. At the end of July 2011, Cook received a three-month evaluation from Director Wasson wherein Wasson praised Cook's work performance and rewarded Cook with pay raises. Id.; see also id. Exh. 5 ("Lori's experiential knowledge has been very evident during her first 90 days! She's identified a number of system and processes issues which has precluded accurate and timely billing; researched and corrected many of those issues consequently reducing the aged accounts receivable by tens of thousands.").
In October and November of 2012, Cook began investigating irregularities in Harrison's billing which she claims could have had Medicare fraud implications. Id. ¶ 9. Cook questioned McKesson's customer service representatives about possible errors in the credit balance reports, overpayment report, and the accounts receivable reconciliation report. Id. On November 6, of 2012, Cook learned from McKesson's customer service representative Tiffany that a process called "Gen End, " which processes the revenue for Medicare charges, was to be updated for revenue only at the end of each month. Id., ¶ 10. Harrison's employees, however, had been running the "Gen End" process every day. Id., ¶ 11 (emphasis added). Cook declares that she was instructed by Harrison to run this process every day despite the instructions in the McKesson software manual to run the process on a monthly basis. Id.
Cook reported her findings to Director Wasson. Id., ¶ 12. On November 7, 2012, Director Wasson and a Human Resource representative, Karen Holland, asked Cook to attend a meeting with them. Id., ¶ 12. At the meeting, Director Wasson informed Cook that the two overpayment reports were supposed to match, but one report stated an $80, 000 balance and the other report stated a $48, 000 balance. Id., ¶ 13. Cook declares that Director Wasson also informed Cook that "this was a serious problem and that [Cook] had probably committed Medicare fraud." Id.
At the end of the meeting, Ms. Holland informed Cook that an internal investigation had been initiated and that Cook was to be placed on suspension immediately. Id., ¶ 14. In March of 2013, Harrison completed its investigation and terminated Cook without pay for the period of suspension from November to March. Id., ¶ 15. In May 2013, Cook sent a written request for information regarding the reason for her termination. Dkt. 23, Declaration of Megan Harry ("Harry Dec."), Exh. 11. On May 9, 2013, Harrison responded and stated that an external audit was conducted on Harrison's billing practices. Id. The audit concluded that "the billing manager lacked the analytical and cross functional expertise needed by a skilled and experienced billing manager." Id. Harrison stated that, because Cook was the billing manager, Harrison concluded that Cook did "not have the necessary skill set required to adequately perform the billing manager job duties and thus terminated [Cook's] employment." Id.
With regard to Medicare fraud, it is undisputed that no fraud was actually committed either intentionally or accidentally.
A. Summary Judgment ...