A federal judge in Louisiana has dismissed with prejudice a qui tam False Claims Act complaint alleging systemic billing fraud and staffing violations at an opioid treatment center in Lake Charles.
The lawsuit, filed by former counselor April Manuel against B H G Holdings L.L.C. and its subsidiaries, alleged that the facility submitted false claims to Medicaid and other government programs while failing to meet federal certification requirements.
Manuel, who worked at the BHG Lake Charles Treatment Center from May 12, 2022, until her termination on October 23, 2023, alleged that the center operated without a required Clinical Supervisor after July 1, 2023. She claimed this staffing gap violated SAMHSA certification requirements and rendered the facility ineligible for Medicaid reimbursement during that period.
The complaint detailed allegations of excessive caseloads, with unlicensed behavioral health professionals managing more than 75 patients each. Manuel further alleged that the center used pre-populated templates to combine patient reassessments and Brief Addiction Monitor responses, shredding physical copies to conceal the practice.
Additional allegations included billing for individual therapy sessions that did not occur, backdating admission and comprehensive assessments for patients who lacked them, and submitting claims for group therapy sessions conducted by unlicensed staff.
Manuel brought ten counts under the False Claims Act, including claims for presenting false claims, using false records, fraudulent inducement, and conspiracy. She also asserted counts for health care fraud under federal criminal law, violations of the Louisiana Medical Assistance Programs Integrity Law, and a whistleblower claim.
In its ruling, Judge James D. Cain Jr. granted the defendants' motion to dismiss all counts with prejudice after Manuel failed to file an opposition. The court held the complaint lacked the particularity required by Federal Rule of Civil Procedure 9(b) for fraud-based claims.
The court held that Manuel failed to identify specific false claims, dates of service, billing codes, or amounts submitted to government payors. The ruling noted that while the complaint described a scheme, it did not plead facts sufficient to connect specific defendants to actionable misconduct with the required specificity.
Judge Cain dismissed the FCA counts for failing to allege specific claims presented to a government payor, improper conversion theories, and insufficient allegations of false certifications or fraudulent inducement. The court also dismissed the conspiracy count for failing to plead a specific agreement among identified actors.
The judge further ruled that Count VIII, alleging health care fraud under 18 U.S.C. § 1347, did not create a private right of action for civil liability. He dismissed the Louisiana Medical Assistance Programs Integrity Law count for relying on generalized descriptions rather than particular Medicaid claims.
The court dismissed the federal whistleblower claim under 42 U.S.C. § 6971, finding it inapplicable as the statute governs solid waste disposal rather than healthcare. Finally, Judge Cain dismissed the vicarious liability count under Louisiana Civil Code Article 2320, noting it does not apply to False Claims Act cases.