Bell v. Cross et al

Middle District of Florida, flmd-8:2016-cv-00961

AMENDED COMPLAINT against 1780 Golden, LLC, 190 Golden, LLC, 21st Financial Lending and Leasing, LLC, 2700 N. Atlantic Land Trust, CSC Trust Holdings, LLC, Karl E. Cross, Tabitha Cross, Cross Garden Care Center, LLC, Cross Landings Inc, LLC, Cross Landings, LLC, Cross Pointe Care Inc, LLC, Cross Senior Care Inc, LLC, Cross Terrace Rehab Inc, LLC, Crossings Retirement Home Inc, LLC, Crosswinds Rehab, LLC, Marline Duroseau, Elder Holdings, LLC, Maria Hernandez, Joyce Plourde, Reliant Rehabilitation, Senior Care 104, LLC, Senior Care 120, LLC, Senior Care 88, LLC, Senior Care CF, LLC, Senior Care WP, LLC, T K Practitioners, LLC, VP of Miami Gardens, LLC, Mary Wood with Jury Demand. filed by Delia Bell. Related document: 1 Complaint filed by Delia Bell.

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5 PageID 82 FILED IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF FLORIDA " MAR 26 Plai. L. ERK US DISTRICT CO MOOLE DISTRICT OF FLURTE .; TAMPA FLORIDA UNITED STATES OF AMERICA - and Case No. 8: 16 - cv - 961 - T - 27AEP THE STATE OF FLORIDA, ex rel. [ UNDER SEAL ] Complaint for Violations of the Federal False Claims Act, 31U.S. C. § 3729 et seq. and the Florida False Claims Act, Fla. Stat. § 68. 081 et seq. Plaintiffs, FILED UNDER SEAL [ UNDER SEAL ] Jury Trial Demanded Defendants CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT 520 5 PageID 84 Hollywood, Florida 33021 CROSS TERRACE REHAB INC, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 CROSSINGS RETIREMENT HOME INC, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 CROSS LANDINGS INC, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 SENIOR CARE 104, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 SENIOR CARE 88, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 SENIOR CARE CF, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 SENIOR CARE WP, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 CROSSWINDS REHAB, LLC CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 5 PageID 86 JOYCE PLOURDE 6511 Nova Drive Suite 168 Davie, Florida 33317 SENIOR CARE 120, LLC 6511 Nova Drive Suite 168 Davie, Florida 33317 MARLINE DUROSEAU 6511 Nova Drive Suite 168 Davie, Florida 33317 MARIA HERNANDEZ 6511 Nova Drive Suite 168 Davie, Florida 33317 MARY WOOD 6511 Nova Drive Suite 168 Davie, Florida 33317 1780 GOLDEN, LLC 6511 Nova Drive Suite 168 Davie, Florida 33317 CSC TRUST HOLDINGS, LLC 4700 Sheridan Street Suite B Hollywood, Florida 33021 CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 5 PagelD 87, 2700 N. ATLANTIC LAND TRUST 4700 Sheridan Street Suite B Hollywood, Florida 33021 INTRODUCTION 1. Qui tam Relator Delia Bell ("Bell " or " Relator"), by her attorneys, individually and on behalf of the United States of America and the State of Florida, file this complaint against Defendants Karl Cross in his individual capacity, Cross Garden Care Center LLC, Cross Landings LLC, Cross Pointe Care Inc. LLC, Cross Senior Care Inc. LLC, Cross Terrace Rehab Inc. LLC, Crossings Retirement Home Inc. LLC, Cross Landings Inc. LLC, Senior Care 104 LLC, Senior Care 88 LLC, Senior Care CF LLC, Senior Care WP LLC, Crosswinds Rehab LLC, T K Practitioners LLC, 21 Financial Lending and Leasing LLC, Elder Holdings LLC, 190 Golden LLC, Senior Care 120 LLC, 1780 Golden, LLC, CSC Trust Holdings, LLC, 2700 N. Atlantic Trust, Brickell Bay Investment Management, LLC, Joyce Plourde, Marline Duroseau, Maria Hernandez, and Mary Wood (collectively, " the Cross Defendants"), Reliant Rehabilitation to recover damages, penalties, and attorneys ' fees for violations of the Federal False Claims Act, 31U.S. C. § 3729 et seq. and the Florida False Claims Act, Fla. Stat. 68. 081 et seq. 2. The Center for Medicare and Medicaid Services ("CMS") adheres to a " 100 day rule " with respect to patients in skilled nursing facilities ("SNF) . Medicare will - at least partially - cover the costs of patient stays in an SNF for the patient's first 100 days at a facility. Beyond this 100 day period, the patient is required to cover all costs of the stay. See Centers for Medicare and Medicaid Services, Medicare Benefit Policy Manual, Chap. 3, Sec. 20. 1; available CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 5 PageID 88 at https: / / www. cms. gov / Regulations - and - Guidance / Guidance / Manuals / downloads / bp 102c03. pdf - last checked Nov. 23, 2009. 3. Despite Karl Cross's elaborate web of overlapping LLCs and shell corporations, the fraud by the Cross Defendants is straight forward. 4. Karl Cross, in his individual capacity, and the Cross Defendants have a company wide policy that requires their medical staff to keep patients on service for 100 days, across the board. This practice is done without regard to patient welfare or medical necessity and is designed solely to maximize reimbursement from Medicare. When the Cross Defendants submit claims to CMS for payment for unnecessary medical services, they are submitting false claims for payment to the government and are liable under the False Claims Act. 5. Reliant Rehabilitation is the company contracted with the Cross Defendants to provide therapy services to residents at the Cross Defendants ' facilities. Reliant Rehabilitation violates the False Claims Act when it provides unnecessary therapy services to residents. When Reliant Rehabilitation then bills CMS for those services, it is submitting false claims for payment to the government and is liable under the False Claims Act. 6. When Bell, a former Administrator at the Cross Garden Care Center facility, complained about this obvious fraud, Karl Cross insisted on billing Medicare for the unnecessary medical services. 7. Bell, reasonably believing that her continued employment was conditioned upon her continuing to unlawfully bill CMS for unnecessary medical services, resigned her position effective August 27, 2015. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 5 PageID 90 17. Immediately prior to joining the Cross Defendants, Bell worked as the Director of Nursing at Jackson Health System and has held numerous other positions related to the administration of healthcare organizations. 18. Bell began working at Cross Garden Care Center in November 2014. 19. Bell resigned her employment with the Cross Defendants effective August 27, 2015. 20. Karl Cross is the founder of Cross Senior Care, a chain of SNFs located throughout Florida and with one location in Georgia. 21. Under the umbrella of Cross Senior Care, Karl Cross operates facilities under the names of: a. Cross Pointe Care Center, 440 Phippen - Waiters Road, Dania Beach, FL 330044 ه b. Cross Terrace, 1351 San Christopher Drive; Dunedin, FL 34698 ن c. Cross Landings, 1780 North Jefferson Street; Monticello, FL 32344 d. The Crossings, 4445 Pine Forest Drive; Lake Worth, FL 33463 e. The Crossroads, 206 West Orange Street; Davenport, FL 33837 f. Crosswinds, 13455 West US Highway 90; Greenville, FL 32331 g. Crossbreeze Care Center, 1755 18th Street; Sarasota, FL 34234 h. Cross Care Center, 5888 Blanding Blvd; Jacksonville, FL 32244 i. Cross Garden Care Center, 190 NE 191st Street; Miami, FL 33179 22. Though relator is still in the process of reviewing Karl Cross's corporate filings, each of the facilities identified in the above paragraph operate under their own LLC or corporation. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 5 Pageld 91, 23. For example, the Cross Garden Care Center facility was owned by Cross Garden Care Center, LLC. Its corporate address was identified as 4700 Sheridan Street, Suite B; Hollywood, Florida 33021. 24. This same address is tied to dozens of other active and inactive liability companies that share some or all of the following characteristics: a. Karl Cross is identified as the organizer or member; b. 4700 Sheridan Street, Suite B, Hollywood, Florida 33021 is identified as the corporate address; and / or c. Fuerst, Ittleman, David and Joseph, PL is identified as the registered agent. 25. Cross Garden Care Center was owned by Cross Garden Care Center, LLC, but is currently owned by an entity formed on June 22, 2016, called Golden 190, LLC. 26. Golden 190, LLC's address is 6511 Nova Drive, Suite 168, Davie, Florida 33317. This address is a UPS store, with the " suite " number being a mailbox in that store. 27. Despite the new ownership, Karl Cross is involved, as Joyce Plourde, the administrator of Cross Garden Care Center, is listed in regulatory filings as its owner. 28. Cross Garden Care Center is still, as of November 2017, listed on Cross Senior Care as one of its ten nursing homes. 29. Marline Duroseau is listed as an Officer for Golden 190, LLC. 30. Maria Hernandez is Managing Employee for Golden 190, LLC. She is also the sole board member, with no ownership interest, of Cross Landings, Inc ., LLC. 31. An amendment to the Golden 190, LLC's regulatory filings lists Mary Ann Wood as a contact for the company. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 10 5 PageID 92 32. Senior Care 120, LLC is listed in regulatory filings as having managerial control of Golden 190, LLC. 33. Since changing hands from Cross Garden Care Center, LLC to Golden 190, LLC Cross Garden Care Center no longer discloses associated entities. 34. Cross Garden Care Center had disclosed working with Volunteer Properties of Miami Gardens and TK Practitioner, both Karl Cross - associated. 35. 1780 Golden, LLC, owned by Joyce Plourde, owns Cross Point Care Center. This entity shares the same mailbox as Golden 190, LLC and several other Karl Cross - associated entities. 36. Karl Cross also established a number of limited liability corporations that serve as the owner of the underlying property upon which the SNF is located. For example, VP of Miami Gardens, LLC owns the land on which the Cross Garden Care Center facility is located. 37. Karl Cross also owns a number of properties identified as, " Volunteer Properties of (Insert City) . " These include but are not limited to: a. Volunteer Properties of Jacksonville, LLC b. Volunteer Properties of Dunedin, LLC c. Volunteer Properties of Davenport, LLC d. Volunteer Properties of Lake Worth, LLC e. Volunteer Properties of Monticello, LLC f. Volunteer Properties of Greenville, LLC g. Volunteer Properties of Sarasota, LLC h. Volunteer Properties of St. Pete, LLC CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 11 Case 8: 16 - cv - 00961 - JDYLAEP Document 20 Filed 03 / 26 / 18Lage 12 of 25 Pageld 93 38. Karl Cross owned Volunteer Properties of Miami Gardens, LLC, but the entity currently lists CSC Trust Holdings, LLC as sole managing member in its regulatory filings. 39. CSC Trust Holdings, LLC's address is 4700 Sheridan Street, Suite B, Hollywood, Florida 33021, the same mailbox as several Karl Cross - associated corporations. The registered agent is Fuerst Ittleman David & Joseph PL, of 1001 Brickell Bay Drive, Miami, Florida 33131. 40. Brickell Bay Investment Management, LLC, lists Karl Cross as its managing member, Fuerst Ittleman David & Joseph as the registered agent, and 4700 Sheridan Street, Suite B, Hollywood, Florida 33021 as its address. 41. Elder Holdings, LLC, lists Karl Cross as its managing member, Fuerst Ittleman David & Joseph as the registered agent, and 4700 Sheridan Street, Suite B, Hollywood, Florida 33021 as its address. 42. Karl Cross uses some of these companies to conduct acquisitions of other nursing homes. For example, Karl Cross purchased All Saints nursing home through one of these Volunteer Properties entities. 43. Karl Cross also owns several entities that provide auxiliary support services to the WUISSE Cross Defendants ' core lines of business. For example, TK Practitioner is an accounting firm that provides financial services to the Cross Defendants. 44. Karl Cross also employs family members at his facilities. For example, Tabitha Quetgles Cross, is a nurse at the Cross Garden Care Center. Medicare reimbursement data reveals that Tabitha Cross billed Medicare for 2, 504 nursing facility evaluations, all typically lasting 15 minutes per - patient. 45. These figures place Tabitha Cross seventh in the State of Florida among more than 1, 200 providers. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 12 5 PageID 94 46. Karl Cross and Tabitha Cross reside at 1841 Harbor Point Circle, Weston, Florida 33327. The nearly $ 900, 000 home is owned by 2012 Cross Trust, whose address is listed in regulatory filings as 4700 Sheridan Street, Suite B, Hollywood, Florida 33021 and which identifies Karl Cross as trustee. 47. 2012 Cross Trust also owns 1531 North Fort Lauderdale Beach Boulevard, Fort Lauderdale, Florida 33304, valued at around $ 3. 1 million. 48. Karl Cross is also associated with 2700 North Atlantic Boulevard, Fort Lauderdale, Florida 33308, which is owned by 2700 N. Atlantic Land Trust, listing Karl Cross as its trustee. This trust resides in 4700 Sheridan Street, Suite B, Hollywood, Florida 33021. 49. Karl Cross uses some of his entities as vehicles to own non - real property, such as a 2006 Bentley Continental, which was registered to 4700 Sheridan Street, Suite B, Hollywood, Florida 33021, with 21s Financial Lending and Leasing, LLC, same address, listed as the lessor until 2011. 50. 2184 Financial Lending and Leasing, LLC has Fuerst Ittleman David & Joseph, PL, of 1001 Brickell Bay Drive, Suite 3112, Miami, FL 33131 as the registered agent; and is managing member CSC Trust Holdings, LLC, of 4700 Sheridan Street, Suite B, Hollywood, Florida 33021, 51. Cross Garden Care Center, alone, has annual revenues of approximately $ 10, 000, 000, the vast majority of which comes from Medicare and Medicaid. 52. As of February 2017, Cross Garden Care Center had had a known cockroach problem based on several accounts from residents of the nursing home. 53. Revenues at the other Cross Senior Care facilities are comparable to that of Cross Garden Care. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 13 5 Pageld 96 beneficiaries, must certify that it will operate in accordance with the requirements established by the Secretary of the Department of Health and Human Services. 62. At all times herein mentioned, the Cross Defendants and Reliant Rehabilitation had knowledge of the public policies expressed in the laws and regulations herein mentioned and of the fact that it must comply with all applicable Federal laws in order for the services Defendants perform to be approved for coverage under Medicare. 63. The State of Florida administers Medicaid services through many facilities, including the Cross Defendants. 64. TriCare is a federal health care program for theU.S. Department of Defense's Military Health System. II. Skilled Nursing 65. Skilled nursing services are those services, furnished pursuant to physician orders, that: 1) Require the skills of qualified technical or professional health personnel such as Registered Nurses ("RN"), LPN ' s, physical therapists, occupational therapists, and speech language pathologists or audiologists; and 2) Must be provided directly by or under the general supervision of these skilled nursing or skilled rehabilitation personnel to assure the safety of the patient and to achieve the medically desired result. 66. CMS adheres to the so - called " 100 Day Rule. " For the first twenty days in a SNF, the resident pays no money out of pocket and all costs are covered by Medicare. 67. For days 21 through 100, Medicare will cover a large percentage of the costs to a resident to stay in an SNF. The first 100 days of SNF coverage are referred to as the " Benefit Period. " 68. After day 100, the resident is responsible for all costs. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 15 5 PageID 98 79. For example, Patient W. S. suffered from schizophrenia but could easily walk, bathe, and perform other every day functions without any assistance whatsoever. 80. Reliant Rehabilitation, at the direction of Karl Cross, provided occupational and physical therapy to Patient W. Ş ., despite the fact that Patient W. S. did not suffer from any physical impairment that required therapy services. 81. Patient J. P. is another example of a patient who received unnecessary therapy services. 82. Patient J. P. was able to ambulate without assistance. 83. Patient J. P ., on numerous occasions, refused the unnecessary therapy services that Reliant Rehabilitation, at the direction of Karl Cross, tried to provide him. 84. Because Patient J. P. refused therapy services, the therapists were unable to take him from his room down to the rehabilitation facility on the first floor. As a result, the therapists performed bedside therapy on Patient J. P ., which amounted to little more than a few minutes of stretching from time to time. v. Utilization Reports, Inflated RUG Rates, and the 100 Day Rule 85. After about a month into her tenure at Cross Garden Care Center, Karl Cross required Bell to submit utilization reports to Joyce Plourde. 86. Joyce Lourde, Administrator at Cross Senior Care's Cross Pointe Care Center facility, served as Karl Cross's de facto second in command. 87. A utilization report is, essentially, a detailed census of the facility. The utilization report includes the patient's name, treatment regimen, RUG level, insurance information, and the number of days that the patient has spent in the facility. CONFIDENTIAL AND UNDER ŞEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 17 Case 8: 16 - cv - 00961 - JDI Document 20 Filed 03 / 2 e 18 of 25 Pageld 99. 88. When reviewing the utilization report, Karl Cross routinely wrote e - mails to the effect of, " We need to get these RUG levels up, " or words to that effect. 89. Bell also began to notice an alarming trend with respect to the timing of resident discharges. 90. As she reviewed the utilization reports, she noticed that Karl Cross and the Cross Defendants kept track of how many days a resident had remaining under Medicare's 100 day Benefit Period. 91. She also noticed that once a patient reached 100 days, the Cross Defendants immediately discharged him or her. 92. The Cross Defendants refused to discharge any, or virtually any, Medicare patients before they reached the end of the 100 day Benefit Period. 93. In addition, the Cross Defendants falsely readmitted patients in order to reset the 100 day Benefit Period. 94. For example, the Cross Defendants routinely transferred Patient W. S ., who suffered from schizophrenia, to Palmetto Psychiatric Unit for three to four day stays. 95. When Patient W. S. was readmitted to Cross Garden Care Center, Karl Cross reset the 100 day Benefit Period. 96. When a patient leaves an SNF but returns within thirty days, he or she is only eligible to continue with the original 100 day Benefit Period. The clock does not reset. In other words, the patient is not entitled to another 100 days beyond that which he has already stayed at an SNF. 97. For Patient W. S ., Medicare should not have paid for another 100 days. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 18 5 PageID 100 98. The Cross Defendants billed Medicare as if Patient W. S, was entitled to another 100 days in the SNF after he spent only a few days at a psychiatric ward. 99. For the ten months that Bell worked at Cross Garden Care Center, Karl Cross discharged zero or virtually zero Medicare patients, including Patients W. S. and Patient J. P ., before they reached the end of their Medicare eligibility period. 100. Cross Garden Care Center generates approximately $ 10, 000, 000 per year in revenue. Bell estimates that roughly $ 6, 000, 000 of this amount is attributable to Medicare patients. 101. Bell estimates that at least half of the $ 6, 000, 000 in Medicare billing is for medically unnecessary services. 102. As the Administrator of the Cross Pointe Care Center facility, Plourde, at Karl Cross's direction, implemented the same scheme to provide medically unnecessary services to patients throughout, and up to, the 100 day Benefit Period. 103. Though Bell did not have access to the Medicare billing at the Cross Pointe Care Center facility as she did at Cross Garden Care Center, both facilities are roughly the same size and it is reasonable to assume that the billing for each is comparable. 104. Plourde and Karl Cross also reviewed utilization reports from other facilities under the Cross Senior Care umbrella. 105. The same practice of providing medically unnecessary services to patients exists at the other Cross Senior Care facilities. VI. Stealing from Medicaid Patients 106. Medicaid patients in Florida receive a small allowance of about $ 105 per month while in an SNF. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 19 5 PageID 101 107. For some patients, the amount of money derived from this allowance accumulated to thousands of dollars because patients had no opportunity to spend the funds. 108. In cases such as this, Cross Garden Care Center took money out of the patients ' individual accounts and placed it in a general facility account. 109. Karl Cross then used the money from this general account to purchase furniture for the SNF. 110. In one example, Cross Garden Care Center took money out of Patient W. S. ' s account to purchase a new television after his other television became inoperable. 111. While the actual cost of the television was no more than $ 90, Cross Garden Care Center took $ 400 out of his account to cover the costs. 112. In another case, Cross Garden Care Center, specifically Tabitha Cross (a nurse), refused to provide a patient with Tylenol because the patient was on Medicaid – not Medicare - and Medicaid would not cover the cost of Tylenol. 113. Tabitha Cross routinely changes or discontinues non - formulary medications in order to avoid the cost of the medication through Medicaid. 114. In other cases, nurses complained to Bell that they were prevented from providing therapy services to Medicaid patients because Medicaid reimbursed at a lower level than Medicare for such services. VII. Bell's Resignation 115. Frustrated by Karl Cross's refusal to treat Medicaid patients and the rampant Medicare fraud, Bell resigned her position in April 2015 to become effective at the end of May 2015. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 20 5 Pageld 102 116. In what was to be her last week of employment, Karl Cross asked that she remain on for another three months so that he could find a replacement. 117. Bell agreed to remain on service for three months, but resigned on August 27, 2015. 118. At the time of her resignation, Karl Cross was continuing his scheme to defraud Medicare. COUNTI Violations of the False Claims Act, 31U.S. C. § 3729 (a) (1) (A) 119. Relator Bell incorporates all of the allegations set forth in the foregoing paragraphs as though fully alleged herein. 120. The False Claims Act imposes liability on any person who knowingly presents or causes to be presented a false or fraudulent claim for payment or approval. 31U.S. C. S 3729 (a) (1) (A) . 121. The Cross Defendants and Reliant Rehabilitation knowingly presented or caused to be presented claims to obtain payment for medically unnecessary services in at least four ways: a. First, the Cross Defendants and Reliant Rehabilitation provide and bill CMS and Tricare for unnecessary physical and occupational therapy services. b. Second, Reliant Rehabilitation, at the direction of Karl Cross, falsely inflates RUG rate levels and bill CMS and Tricare at the inflated rates. c. Third, the Cross Defendants and Reliant Rehabilitation refuse to discharge patients before they reach the end of their 100 day Benefit Period. This means that CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 21 5 PageID 103 the Cross Defendants are billing CMS and Tricare for a large percentage of residents, including Patient W. S and Patient J. P ., that are ineligible for treatment at an SNF. d. Fourth, the Cross Defendants and Reliant Rehabilitation inappropriately re - admit patients and reset their 100 day Medicare Benefit Period when patients leave Cross Senior Care facilities for only a few days at a time. 122. The aforementioned conduct has led and continues to lead the Government through Medicare and TriCare - to pay for medically unnecessary services, for which Defendant received payments of millions of dollars from the federal Medicare program and numerous state Medicaid programs. 123. The United States of America has been damaged by all of the aforementioned misrepresentations and failures to comply with requisite laws and regulations in an as of yet undetermined amount. COUNT II Violations of the False Claims Act, 31U.S. C. & 3729 (a) (1) (B) 124. Relator Bell incorporates all of the allegations set forth in the foregoing paragraphs as though fully alleged herein. 125. The False Claims Act imposes liability on any person who knowingly makes, uses, or causes to be made or used a false record or statement material to a false or fraudulent claim. 31U.S. C. § 3729 (a) (1) (B) . 126. Defendants knowingly made or caused to be made a false record or statement to a false claim when they created false narratives in patient notes to justify their decision to provide services in excess of what is medically necessary. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 22 Case 8: 16 - CV - 00961 - JDYALAEP Document 20 Filed 03 / 26 / 18mfage 23 of 25 PageID 104 127. The result of Defendants ' actions has led the Government to pay for medically unnecessary services, for which Defendants received payments of millions of dollars from the Medicare and Medicaid programs. 128. The United States of America has been damaged by all of the aforementioned misrepresentations and failures to comply with requisite laws and regulations in an as of yet undetermined amount. COUNT III Violations of the Florida False Claims Act, Fla. Stat. & 68. 082 (2) (a) 129. Relator Bell incorporates all of the allegations set forth in the foregoing paragraphs as though fully alleged herein. 130. The Florida False Claims Act imposes liability on any person who knowingly presents or causes to be presented a false or fraudulent claim for payment or approval, Fla. Stat. $ 68. 082 (2) (a) . 131. Defendants violated the Florida FCA by appropriating patient allowances and using those funds to purchase furniture and equipment for their facilities. 132. The result of Defendants ' actions has led the state of Florida to pay for medically unnecessary devices and supplies, for which Defendants received payments from Medicaid. 133. The State of Florida has been damaged by all of the aforementioned misrepresentations and failures to comply with requisite laws and regulations in an as of yet undetermined amount. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 23 Case 8: 16 - CV - 00961 - JDW. AEP Document 20 Filed 03 / 26 / 18 page 24 of 25 PageID 105, PRAYER FOR RELIEF WHEREFORE, Relator Bell, acting on behalf of and in the name of the United States of America, and on her own behalf, pray that judgment will be entered against Defendants for violations of the Federal False Claims Act, 31U.S. C. 3729 et seq. and the Florida False Claims Act, Fla. Stat. 8 68. 081 et seq. as follows: a) That for violations of the False Claims Act, 31U.S. C. $ 3729, et seq ., this Court enter judgment against the Defendants in an amount equal to three times the amount of damages the United States Government has sustained because of the Defendants ' actions, plus a civil penalty of $ 11, 000 for each act in violation of 31U.S. C. 83729; b) That for violations of the Florida False Claims Act, Fla. Stat. $ 68. 081, et seq ., this Court enter judgment against the Defendants in an amount equal to three times the amount of damages the State of Florida has sustained because of the Defendants ' actions, plus a civil penalty of $ 11, 000 for each act in violation of Fla. Stat. § 68. 081, et seq; c) That Relator Bell be awarded the maximum amount allowed pursuant to 31U.S. C. $ 3730 (d), including the costs and expenses of this action and reasonable attorneys ' fees; d) That the United States Government and Relator Bell receive all other relief, both in law and equity, to which they are reasonably entitled. CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell, v. Karl Cross, et. al. 24 5 PageID 106 JURY DEMAND Pursuant to Rule 38 of the Federal Rules of Civil Procedure, Relator Bell hereby demands a jury trial. March 20, 2018 Respectfully Şubmitted, Hold Oswald R. Scott Oswald Florida State Bar No .: 158437 David Scher (to be admitted pro hac vice) The Employment Law Group, P. C. 888 17th Street, NW, Suite 900 Washington, D. C. 20006 (202) 261 - 2803 (202) 261 - 2835 (facsimile) soswald @ employmentlawgroup. com dscher @ employmentlawgroup. com Attorneys for Qui Tam Plaintiffs CONFIDENTIAL AND UNDER SEAL - QUI TAM COMPLAINT United States ex rel. Delia Bell. v. Karl Cross, et. al. 25