XXX DISTRICT COURT
FOR THE WESTERN DISTRICT OF XXX
XXX,
Plaintiff, vs. XXX OFFICE OF THE ATTORNEY GENERAL, et al., Defendants |
Case No.: CIV – XXX |
PLAINTIFF’S OPPOSITION TO DEFENDANTS’ MOTION TO DISMISS PLAINTIFF’S COMPLAINT
COMES NOW Plaintiff, XXX, Pro-se, hereby files this Motion to request this Honorable Court to order the disclosure of the Discovery Requests mentioned herein against Defendants, pursuant to Rule 6, and 26 of the Federal Rules of Civil Procedure.
INTRODUCTION
The plaintiff invokes this Court’s Federal Question Jurisdiction pursuant to 28 USC 1331. Notably, Plaintiff’s case involves the violation of Federal laws, inter alia, Tile 42 USC 1983 and 42 USC 1985 (3). The Plaintiff states that the actions by the Defendants are unconstitutional and that the Plaintiff has suffered and is suffering irreparable harm and request the Court to address Plaintiff’s case in the interest of justice.
For the past five years, the Defendant have subjected the Plaintiff to a criminal trial in the State court. The Defendants violating Plaintiff’s due process rights, and failed to apply proper procedure, in conducting investigations for Plaintiff’s alleged offense.
The court may open the doors for relief against government officials who act under the color of law to violate the Constitutionally guaranteed rights of individuals. Notably, the immunity of State actors from a suit has long been held not to extend to actions against the state official for damages arising out of the willfulness, negligent disregard of state law.
FACTUAL BACKGROUND
During the end of XXX the XXX Health Care Authority (OHCA) began an investigation into Plaintiff’s business (Briggs) unbeknown to Plaintiff. The said investigation was based on complaints from disgruntled employees involving misdeeds committed by those same employees.
OHCA, instead of investigating the wrongdoers, began an investigation into Plaintiff. These investigations did not follow due process guidelines in regard Medicaid fraud. Per 42 CFR 431.107, before any action is taken against Plaintiff, Plaintiff needs to keep records and pursuant 74 Oklahoma statute 8541, OHCA and the Oklahoma State auditor and the inspector will have the right to examine the provider’s books.
Shortly thereafter, Plaintiff’s business was terminated.
Consequential to the termination, Plaintiff transitioned her clients to Options Unlimited, a company owned by XXX. At this time, Plaintiff reasonably believed that all relevant protocols were being adhered to during the transition period. Accordingly, Plaintiff relied on Kimberly Shoals.
On or about the 20th day of XXX, the State of XXX, by and through unconstitutional actions of the staff of the Attorney General’s office, charged Plaintiff- a former employee of XXX to having conspired to commit several counts of Medicaid fraud. The
said charge was brought by information from Kimberly Shoals.
The allegations mentioned above lacked evidence.
On or about XXX, the State of Oklahoma, by and through illegal conduct of staff of the Attorney General’s office, moved to the District Court of XXX County through Magistrate XXX, to dismiss all counts against XXX, who was the only medical provider on the date and time of the alleged offenses charged by the State. See Preliminary Hearing Transcript of XXXX & AAG Testimony Da v 1 Attached Exhibit “A”. Services, Briggs Therapeutic CDC, Briggs Intensive Youth Development Services and Exceptional Minds for years XXX
ARGUMENTS
- PLAINTIFF PROPERLY SERVED THE DEFENDANTS
Under Federal Rule of Civil Procedure 12(b)(5), “[w]hen service of process is challenged, the serving party bears the burden of proving its validity or good cause for failure to effect timely service.” Sys. Signs Supplies v. U.S. Dep’t of Justice, Washington, D.C., 903 F.2d 1011, 1013 (5th Cir. 1990). Also, it has been held that “When a defendant moves to dismiss under Rule 12(b)(5), the plaintiff bears the burden of proving adequate service.” Dickerson v. Napolitano, 604 F.3d 732, 752 (2d Cir. 2010). It is also worth noting that the Court may consider declarations in resolving Rule 12(b)(5) motions. See Riley v. Office of Alcohol & Tobacco Control of Louisiana Dep’t of Revenue, No. CV 18-6984, 2018 WL 6651082, at *3 (E.D. La. Dec. 19, 2018). Further, in Cutler Assocs., Inc. v. Palace Constr., LLC, 132 F. Supp. 3d 191, 194 (D. Mass. 2015), the honorable court held that “[a]ny factual ambiguities [in solving Rule 12(b)(5) motions] are to be resolved squarely in the plaintiff’s favor.”
Defendants argue that Plaintiff improperly served the Defendants and totally failed to effect service on others. Contrariwise, Plaintiff avers that she properly served the Defendants with both summons and complaint and the same were mailed in compliance with the Federal Rules of Civil Procedure 4(2). Plaintiff maintains that the summons and complaint were duly received by the Defendant’s or their agents. Notably, an agent authorized by appointment or by law was served. And the said agent signed for the mail. On the security protocols, no one has Kevin Colbert’s home address, following the restrictions on publishing of certain officials’ home addresses. See Publius v. Boyer-Vine, No. 1:2016cv01152 – Document 24 (E.D. Cal. 2017).
Thus, Plaintiff holds that the Defendants were properly served. The initial federal complaint filings were filed in The Western District Court of Oklahoma on XXX to all the Defendants. Due to the USPS time delay in delivery of service, three defendants (Joel Nico Gomez, Lisa Gifford, and Carrie Evans) were mailed again to the XXX Health Care Authority on XXX and was shown successfully delivered. One Defendant (XXXX) was resent on XXX to an out of state address and was returned XXX. XXX was filed in legal publication with Deforest Times-Tribune on XXX for three weeks. All Defendants were filed under legal publication with the Journal Record on XXX. After receiving no responses after a month, the Plaintiff sought advice and realized that previous federal complaints were erroneously filed without the court summons. Therefore, summons was filed in the courts and a certified copy of summons with federal complaint were sent to all Defendants on XXX. The courts made the Plaintiff aware that the previous sent federal complaints would be null and void and the clock did not start until the summons was stamped in on XXX. All Defendants have been successfully delivered except for one defendant in pending status (XXX). Summons’s publication is pending for XXX in the Journal Record for all defendants. See Exhibit 1-Copies of Certified Copies and Publications.
- THIS COURT HAS JURISDICITON OVER THE STATE OFFICIALS. THEREFORE, PLAINTIFF VALIDLY EFFECTED SERVICE ON THE STATE OFFICIALS.
Although the 11th amendment protects State Officials from actions against them, Courts may open their doors for relief against government wrongs under the doctrine that sovereign immunity does not prevent a suit to restrain individual officials, thereby restraining the government as well. See, Larson v. Domestic and Foreign Corp., 337 U.S. 682 (1949). A suit against an official is not a suit against the government, but for the purpose of finding state action to which the Constitution applies, the official’s conduct is that of the state. See C. Wright, The Law of Federal Courts § 48 (4th ed. 1983).
In Ex Parte Young, 209 U.S. 123 (1908), Plaintiffs brought a federal action to enjoin Young, the state attorney general, from enforcing the law, alleging that it was unconstitutional and that they would suffer irreparable harm if he were not prevented from acting. In deciding the case, the Court relied on Davis v. Gray, 83 U.S. (16 Wall.) 203 (1872), where it was held that the fact that the officer sued may be acting on behalf of the state or in response to a statutory obligation of the state did not make the suit one against the state. It is also worth noting that the general criterion for determining when a suit is in fact against the sovereign is the effect of the relief sought. Virginia Office for Protection and Advocacy v. Stewart, 563 U.S. ___, No. 09–529, slip op. at 8 (2011) (quoting Pennhurst State School & Hospital v. Halderman, 465 U.S. at 107).
Also, the immunity of a state from suit has long been held not to extend to actions against state officials for damages arising out of willful and negligent disregard of state laws. Johnson v. Lankford, 245 U.S. 541 (1918). The reach of the rule is evident in Scheuer v. Rhodes, 416 U.S. 233 (1974), in which the Court held that plaintiffs were not barred by the Eleventh Amendment or other immunity doctrines from suing the governor and other officials of a state alleging that they deprived plaintiffs of federal rights under color of state law and seeking damages, when it was clear that plaintiffs were seeking to impose individual and personal liability on the officials. There was no “executive immunity” from suit, the Court held; rather, the immunity of state officials is qualified and varies according to the scope of discretion and responsibilities of the particular office and the circumstances existing at the time the challenged action was taken.
The Defendants also allege that the State cannot be identified as a “person” under a Section 1983 claim. Indeed, the judicial interpretation of “person” under Section 1983 is complex. However, the U.S. Supreme Court has traditionally indicated that State officers can be sued under “color of state law” meaning power “possessed by virtue of state law and made possible only because the wrongdoer is/was clothed with the authority of state law”. See West v. Atkins, 487 U.S. 42 (1988). This means that a state employee performing a governmental function, even if exceeding her/his authority, is acting under color of law. The Supreme Court has also held that State Officers can be held liable under Section 1983 for actions taken with “deliberate indifference”. Farmer v. Brennan, 511 U.S. 825 (1994).
The Defendants also allege that the Plaintiff failed to indicate the Constitutional right that was violated. Indeed, to state a Section 1983 claim, the plaintiff must allege that the defendant 1) deprived the plaintiff of a right secured by the U.S. Constitution while 2) acting under color of state law. See Collins v. Womancare, 878 F.2d 1145, 1147 (9th Cir. 1989). Contrary to the Defendants’ assertions, the Plaintiff’s complaint duly mentioned the rights that were violated by the Defendants. Notably, in the first Count, the Plaintiff avers that the Defendants violated Plaintiff’s due process rights as guaranteed by the 5th and 14th Amendments. Under Count 2, Plaintiff alleges official misconduct against the Defendants in violation of 42 U.S.C. § 1983 & and 42 U.S.C. § 1985. In that regard, the Defendants’ averments that the Plaintiff failed to cite any violation does not hold ground and should be dismissed.
- PLAINTIFF’S COMPLAINT STATES CLAIMS UPON WHICH RELIEF CAN BE GRANTED. HENCE, DEFENDANT’S MOTION TO DISMISS UNDER RULE 12(B) 6 SHOULD BE DISMISSED.
A motion to dismiss under Rule 12(b)(6) is disfavored and rarely granted. Hall v. City of Santa Barbara, 833 F.2d 1270, 1274 (9th Cir. 1986) (“It is axiomatic that ‘[t]he motion to dismiss for failure to state a claim is viewed with disfavor and is rarely granted.'”) (quoting Charles Alan Wright & Arthur R. Miller, Federal Practice & Procedure 1357, at 598.
The U.S. Supreme Court has stated: “The issue is not whether a plaintiff will ultimately prevail but whether the claimant is entitled to offer evidence in support of the claims. Indeed, it may appear on the face of the pleadings that a recovery is very remote and unlikely, but that is not the test.” Scheuer v. Rhodes, 416 U.S. 232, 236 (1974). Rather, “a complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Conley v. Gibson, 355 U.S. 41, 45-46 (1957).
“In reviewing the allegations, this Court construes the complaint in a light most favorable to the plaintiff, accepting all of the factual allegations as true and determines whether the plaintiff can prove no set of facts in support of his claims that would entitle him to relief.” Arrow v. Fed. Reserve Bank of St. Louis, 358 F.3d 392, 393 (6th Cir. 2004).
Courts rarely grant a dismissal of a complaint without leave to amend. “Dismissal without leave to amend is improper unless it is clear, upon de novo review, that the complaint could not be saved by any amendment.” Schneider v. California DOC, 151 F.3d 1194, 1196 (9th Cir. 1998). Further, “Amendment should be refused only if it appears to a certainty that plaintiff cannot state a claim.” Wright and Miller, Federal Practice and Procedure, vol 5A, 1357.
Under the color of state law, the defendants in the instant case initiated an illegal investigation, and that prior to filing any charges, there had to be an audit to determine whether that was a violation of law or not. The Oklahoma Medicaid fraud control unit were to do an audit of the plaintiff’s facility to determine whether a crime or a violation has occurred. This is required under state law. Upon the conclusion of the audit, it was to be referred to the Attorney general’s office. It is striking that no audit was conducted yet the officer or investigator went to the judge and stated that an audit was done. This was a violation of both the 5th and the 14th amendments of the U.S. Constitution.
Plaintiff avers that she was working under Mrs. Shoals. The Plaintiff further avers that Mrs. Shoals was the provider while she (Plaintiff) was an employee. It is worth noting that prior to filing a charge on the plaintiff, the Attorney general’s office and the Oklahoma health Care unit stole 154,600.00 from Mrs. shoals.
- THE YOUNGER DOCTRINE DOES NOT APPLY TO THE INSTANT CASE. THEREFORE, THIS HONORABLE COURT HAS JURISDICTION TO HEAR PLAINTIFF’S CASE.
The mere presence of concurrent State court litigation involving the same parties or issues does not justify its abdication. Colorado River Water Conservation Dist. v. United States, 424 U.S. 800, 813-14, 817-18 (1976). In Sprint Communications, Inc. v. Jacobs, 690 F. 3d 864 (2013), the U.S. Supreme Court applied a narrow interpretation to the Younger doctrine. Per the Court, Federal Courts should abstain from deciding cases only in “exceptional” circumstances. Therefore, Younger would not apply if the prosecution is in bad faith; the prosecution is part of some pattern of harassment against an individual; or the law being enforced is flagrantly and patently unconstitutional. The Court emphasized that abstention pursuant to Younger v. Harris is not appropriate merely because a state court is considering a case involving the same subject matter. Accordingly, the Supreme Court noted that the proceedings were not criminal and did not impact the ability of the state court’s ability to perform its functions. It further found that the proceeding was not a civil state enforcement action requiring abstention. It follows; the Supreme Court decision in Sprint Communications, Inc. 690 F. 3d 864 (2013) prevents an open-ended standard from being applied to abstention under the Younger doctrine.
The Plaintiff in the instant case avers Younger does not apply to her case because the State instituted criminal charges against her in bad faith. They are well aware that the Plaintiff is innocent of the charges brought against her. Also, the Defendants are part of some pattern of harassment against the Plaintiff. It follows; the charges raised against her are mere allegations actuated by malice and bad faith.
The Plaintiff also alleges that the State actors are in violation of her Constitutionally guaranteed rights. Plaintiff also alleges that the State actors attempted to strong arm the plaintiff for $644,264.32 in which they have no claim of record who the money is owed too. It is a principle in equity that he who comes to equity must have clean hands. It follows; the Defendants should not be granted audience in this honorable court because they violated Plaintiff’s rights. They also disregarded the required procedure by failing to conduct an audit before bringing a charge against the Plaintiff.
- THE PLAINTIFF HAS A VALID § 1983 CLAIM; THE HECK DOCTRINE DOES NOT APPLY TO PLAINTIFF’S CASE.
Finality and consistency are important to the integrity of the judicial system; § 1983 claims that would jeopardize those principles are properly barred under Heck v. Humphrey, 512 U.S. 477, 501 (1994). (However, in situations where a petitioner’s civil action does not necessarily imply the invalidity of another’s conviction, Heck should not be used to preclude the claim because it stretches Heck far beyond what it was intended to avoid. A strict reliance on the Heck doctrine is troubling because it might “deny any federal forum for claiming a deprivation of federal rights. Per Justice Souter in Heck, a convicted criminal’s federal claims against state actors always deserve an opportunity to be heard in a federal forum. Justice Souter describes the absence of such an opportunity as an “untoward result.” Heck, 512 U.S. 477, 501 (1994), at 500-01.
Defendants allege that the Heck doctrine bars the Plaintiff from filing the current § 1983 claim. They argue that any guilty plea or conviction from Plaintiff’s criminal case would call into question her claims in her Complaint. However, Plaintiff avers that an alleged violation of an individual’s legal rights demands an opportunity for redress. There can be no more equitable proposition than this, for right and remedy go hand in hand. The U.S. Supreme Court has described the purpose of § 1983 as “interpos[ing] the federal courts between the States and the people, as guardians of the people’s federal rights.” Mitchum v. Foster, 407 U.S. 225, 242 (1972).
- THE PLAINTIFF HAS VALID CLAIMS AGAINST THE DEFENDANTS
The Plaintiff reiterates that all the Defendants are rightly included in the Complaint. Hereinbelow, she categorically states how each Defendant participated in the violations.
- TRAVIS KIRKPATRICK-OHCA
Travis Kirkpatrick worked for Oklahoma Health Care Authority (OHCA)-Position-Medicaid Fraud/Civil Rights Investigator. Job duties was to investigate complaints of Medicaid Fraud among members and providers. Conducted administrative and civil rights investigations involving agency employees.
Travis started the investigation for Briggs around April 2011 with Constance Lindley, which was a biller for Briggs companies. He received a total of five complaints from Briggs employees only: no Medicaid recipients. Mr. Kirkpatrick investigation was limited to only interviewing the five employees and failing to follow through with 455.13 the methodology of the complaints nor conducting a preliminary investigation 455.14 before writing up his referral. The referral (Exhibit 1-Referral) was only written for Briggs Therapeutic CDC, which is only one location of four that Janice Wrenn owned. The referral was stamped and dated for April 2, 2013 with the legal division but was not sent over to the MFCU unit until June 10, 2013, which is after the Briggs companies was terminated. Mr. Kirkpatrick one referral was not only inconsistent with policies and procedures for 455.13 and 455.14, but it also failed to have complete information to determine the specifics of the Medicaid Fraud allegation which was the statue, rules, policies violated, date and date range of submitted claims and the approximate potential overpayment amount per allegation.
Mr. Kirkpatrick failed to complete a referral per Briggs companies which were all separate entities according to law. Briggs Family and Youth Association, Briggs Behavioral Health Services, Briggs Therapeutic CDC, and Briggs Intensive Youth Development Services. These companies where provider numbers were listed in the body of the text of the referral but was not written as separate entities per allegation that he investigated upon. Each referral is a statue and process of its own per company.
When Mr. Kirkpatrick failed to conduct a complete preliminary investigation 455.14, before referring to the MFCU unit, which violated Plaintiff’s constitutional rights to an audit review, administrative appeals process, suspension appeals process and right to face her accusers.
Mr. Kirkpatrick also failed to appear to the only hearing that Plaintiff was offered to attend, which was the Post-Termination Hearing. Mr. Kirkpatrick failed appearance gave Plaintiff no opportunity to cross examine him as the investigator nor cross examine any of the five employees that he so-called investigated for credible allegations of fraud.
Mr. Kirkpatrick failed to issue outcome of QA reports/any reports or communications during investigative process.
Ms. Nantois signed off on a letter of termination two weeks before Plaintiff completed and passed her onsite visit and received two of her facility renewals. This process was continued after Travis Kirkpatrick and Jeremiah Streck stated they found credible allegations of fraud. Contract renewals is a procedure, so therefore Plaintiff began her application process with payment of $500 per both applications without any denial’s. The renewals demonstrated that Ms. Nantois did not follow due process because there was never any communication from Oklahoma Health Care Authority to Plaintiff that she was under any investigation and was approved her renewals from March into early May of 2013. Plaintiff has gone through previous renewals with OHCA twice before her termination. Plaintiff’s renewals shown approved and updated in her billing system after the onsite visit conducted Mid-April 2013. See Exhibit 1-Referral to MFCU (70 pgs.); Exhibit 2-Panel Hearing Transcript (included in initial filing of complaint); Exhibit 3-Outcome of Panel Hearing Letter; Exhibit 4-OHCA Policies and Procedures for Fraud and Audits; Exhibit 5-CMS Medicaid Guidelines for State Agencies; Exhibit 6- Audit Findings Report for Options Unlimited 2013; and Exhibit 7- Briggs Renewals in 2013.
- JEREMIAH STRECK-OHCA
Jeremiah Streck worked for the Oklahoma Health Care Authority (OHCA)-Position-Deputy General Counsel. Job duties to include the following: The Deputy General Counsel reports to the General Counsel (GC) and provides legal advice to the agency and board and represents OHCA in both administrative and judicial proceedings. Assists senior attorneys with legal research, drafting, and discovery.
- Represents the agency in estate recovery/third party liability recovery of funds. This may include court appearances for the agency, preparation of pleadings in state and federal court, negotiation with counsel and review of trust documents.
- Analyzes, reviews and determines impact of proposed legislation.
- First- and second-chair responsibility in administrative hearings in both member and provider appeals.
- Coordinates with the Office of the Attorney General concerning Attorney General Opinion requests.
- Analyzes, research and reviews subpoenas and other requests under the Open Records Act, HIPAA and/or Medicaid confidentiality laws.
- Attends task force meetings as a representative of the agency as assigned by the Chief Executive Officer and provides accurate information to the task force regarding Oklahoma Medicaid program.
- Assists in the coordination of referrals and investigative efforts with the Office of the Attorney General/Medicaid Fraud Control Unit (MFCU).
- Second- and first-chair responsibility in state and federal court proceedings involving the agency, including drafting of pleadings and discovery, motions hearings, depositions and trial.
- Other duties as assigned.
See Exhibit 1-Referral letter sent to MFCU; Exhibit 2-Referral (70 pgs.); Exhibit 3-Termination Letter; Exhibit 4-Outcome of Panel Hearing Letter; Exhibit 5-Panel Hearing Transcript (included in initial filing of complaint); Exhibit 6- Briggs Renewals in 2013; Exhibit 7- Audit Findings Report for Options Unlimited 2013; Exhibit 8–OHCA Policies and Procedures for Fraud and Audits; and Exhibit 9-CMS Medicaid Guidelines for State Agencies.
XXX failed to coordinate a preliminary investigation upon receiving the complaints from the five employees through Travis Kirkpatrick before filing the referral with the MFCU. Not only did XXX violate Plaintiff’s procedural due process in not conducting 455.13 and 455.14 before referral. He signed off the referral that was sent over to the MFCU sixty days after the referral was stamped into the legal division April 2, 2013.
XXX failed to complete 455.14-Preliminary Investigation, in establishing an audit to support the complaints and credible allegations of fraud.
XXX failed to follow code 455.17 in reporting any and all adverse actions of credible allegations of fraud to CMS.
XXX failed to follow code 455.18 by not reporting any overpayments or claims related to credible allegation of fraud.
XXX failed to follow code 455.23 to report any payment suspensions before, during or after the termination of Briggs company contracts. Mr. Gomez and peers failed to also report any and all necessary notices to not suspend with CMS, MFCU and secretary of state.
XXX failed to assure that federal regulations was adhered to from the beginning of the complaints to the panel termination hearing.42 CFR- 455.13, 455.14. 455.17, 455.19,455.20, 455.23.
XXX signed off on a letter of termination two weeks before Plaintiff completed and passed her onsite visit and received two of her facility renewals. This process was continued after Travis Kirkpatrick and XXXX stated they found credible allegations of fraud. Contract renewals is a procedure, so therefore Ms. Briggs began her application process with payment of $500 per both applications without any denial’s. The renewals demonstrated that XXX did not follow due process because there was never any communication from Oklahoma Health Care Authority to Plaintiff that she was under any investigation and was approved her renewals from March into early XXX. Plaintiff has gone through previous renewals with OHCA twice before her termination. Plaintiff renewals shown approved and updated in her billing system after the onsite visit conducted Mid-XXX
- XXX
XXX worked for the Oklahoma Health Care Authority (OHCA), Position-General Counsel. Job duties to include the following: The Deputy General Counsel reports to the General Counsel (GC) and provides legal advice to the agency and board and represents OHCA in both administrative and judicial proceedings. Assists senior attorneys with legal research, drafting, and discovery.
- Represents the agency in estate recovery/third party liability recovery of funds. This may include court appearances for the agency, preparation of pleadings in state and federal court, negotiation with counsel and review of trust documents.
- Analyzes, reviews and determines impact of proposed legislation.
- First- and second-chair responsibility in administrative hearings in both member and provider appeals.
- Coordinates with the Office of the Attorney General concerning Attorney General Opinion requests.
- Analyzes, researches, and reviews subpoenas and other requests under the Open Records Act, HIPAA and/or Medicaid confidentiality laws.
- Attends task force meetings as a representative of the agency as assigned by the Chief Executive Officer and provides accurate information to the task force regarding Oklahoma Medicaid program.
- Assists in the coordination of referrals and investigative efforts with the Office of the Attorney General/Medicaid Fraud Control Unit (MFCU).
- Second- and first-chair responsibility in state and federal court proceedings involving the agency, including drafting of pleadings and discovery, motions hearings, depositions and trial.
- Other duties as assigned.
See Exhibit 1- Termination Letter; Exhibit 2-Referral (70 pgs.); Exhibit 3-Outcome of the Termination Letter; Exhibit 4-Panel Hearing Transcript (included in initial filing of complaint); Exhibit 5-Recording with Lory Dewey; Exhibit 6-Briggs Renewals in 2013
Exhibit 7- Audit Findings Report for Options Unlimited 2013; Exhibit 8–OHCA Policies and Procedures for Fraud and Audits; and Exhibit 9-CMS Medicaid Guidelines for State Agencies.
XXX failed to complete 455.14-Preliminary Investigation, in establishing an audit to support the complaints and credible allegations of fraud.
XXX failed to follow code 455.17 in reporting any and all adverse actions of credible allegations of fraud to CMS.
XXX failed to follow code 455.18 by not reporting any overpayments or claims related to credible allegation of fraud.
XXX failed to follow code 455.23 to report any payment suspensions before, during or after the termination of Briggs company contracts. Mr. Gomez and peers failed to also report any and all necessary notices to not suspend with CMS, MFCU and secretary of state.
XXX stated in in the panel hearing “that this is your due process” and failed to relay any administrative procedures throughout the panel hearing process.
XXX signed off on a letter of termination two weeks before Plaintiff completed and passed her onsite visit and received two of her facility renewals. This process was continued after XXX stated they found credible allegations of fraud. Contract renewals is a procedure, so therefore Plaintiff began her application process with payment of $500 per both applications without any denial’s. The renewals demonstrated that XXX did not follow due process because there was never any communication from XXX Health Care Authority to Plaintiff that she was under any investigation and was approved her renewals from March into early May of XXXX. Plaintiff has gone through previous renewals with OHCA twice before her termination. Ms. Briggs renewals shown approved and updated in her billing system after the onsite visit conducted Mid-April XXX.
- XXX
XXX worked as a CEO Director for the Oklahoma Health Care Authority (OHCA). Job duties are Manages and supervises the operations and activities of a roughly 500-person state Agency with an operational budget of roughly five billion dollars in the pursuit of its primary stated mission, To Operate and Administer the XXX State Medicaid Program, to purchase all State-funded health care in the most efficient and comprehensive manner possible, and to study and recommend strategies for containing costs and optimizing the delivery of health care in State programs.
Other duties include: Coordinates and promulgates current and long-range goals, objectives, budgets, plans and policies, subject to approval by the OHCA Board of Directors. Plans, coordinates, and supervises the daily operation of the organization through direct consultation and coordination with the organization’s executives and line management. Dispenses advice, guidance, direction, and authorization to carry out major plans, standards, and procedures, consistent with all applicable state and federal laws, rules, regulations, and policies. Meets with organization’s executives and managers to monitor and ensure that operations are being executed in accordance with the Board’s policies. Directly oversees the adequacy and soundness of the organization’s budget and fiscal structure. Reviews operating results of the organization compares them to approved objectives and takes steps to ensure that appropriate measures are taken to correct unsatisfactory results. Establishes and maintains an effective system of communications throughout the organization. Represents the organization with multiple stakeholder groups, provider groups, federal and state over site agencies, the state legislature and executive branch individuals and committees. See Exhibit 1-Referral (70 pgs.); Exhibit 2-Termination Letter
Exhibit 3-Outcome of Panel Hearing Letter; Exhibit 4-Panel Hearing Transcript (included in initial filing of complaint); Exhibit 5-Qurterly Board Meetings for XXX; Exhibit 6-Outcome of Panel Hearing Letter; Exhibit 7-Audit Findings Report for Options XXX; Exhibit 8-OHCA Policies and Procedures for Fraud and Audits; and Exhibit 9-CMS Medicaid Guidelines for State Agencies.
Mr. Gomez failed to assure that his peers followed through with federal procedures in 42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
XXX failed to complete 455.14-Preliminary Investigation, in establishing an audit to support the complaints and credible allegations of fraud.
XXX failed to follow code 455.17 in reporting any and all adverse actions of credible allegations of fraud.
XXX failed to follow code 455.18 by not reporting any overpayments or claims related to credible allegation of fraud. XXX failed to follow code 455.23 to report any payment suspensions before, during or after the termination of Briggs company contracts. XXX and peers failed to also report any and all necessary notices to not suspend with CMS, MFCU and secretary of state.
- XXX
XXX worked as a CEO Director for the Oklahoma Health Care Authority. Job duties are Manages and supervises the operations and activities of a roughly 500-person state Agency with an operational budget of roughly five billion dollars in the pursuit of its primary stated mission, To Operate and Administer the XXX State Medicaid Program, to purchase all State-funded health care in the most efficient and comprehensive manner possible, and to study and recommend strategies for containing costs and optimizing the delivery of health care in State programs.
Other duties include: Coordinates and promulgates current and long-range goals, objectives, budgets, plans and policies, subject to approval by the OHCA Board of Directors. Plans, coordinates, and supervises the daily operation of the organization through direct consultation and coordination with the organization’s executives and line management. Dispenses advice, guidance, direction, and authorization to carry out major plans, standards, and procedures, consistent with all applicable state and federal laws, rules, regulations, and policies. Meets with organization’s executives and managers to monitor and ensure that operations are being executed in accordance with the Board’s policies. Directly oversees the adequacy and soundness of the organization’s budget and fiscal structure. Reviews operating results of the organization compares them to approved objectives and takes steps to ensure that appropriate measures are taken to correct unsatisfactory results. Establishes and maintains an effective system of communications throughout the organization. Represents the organization with multiple stakeholder groups, provider groups, federal and state over site agencies, the state legislature and executive branch individuals and committees.
See Exhibit 1-Referral (70 pgs.); Exhibit 2-Termination Letter; Exhibit 3-Outcome of Panel Hearing Letter; Exhibit 4-Panel Hearing Transcript; Exhibit 5-OHCA Policies and Procedures for Fraud and Audits; Exhibit 6-CMS Medicaid Guidelines for State Agencies; Exhibit 7-Complaint faxed to legal division April of 2019.; Exhibit 8-Emails sent to CMS Regional 6 Director; and Exhibit 9-Email sent to OHCA for requests and complaints XXX.
XXX failed to assure that his peers followed through with federal procedures in 42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
XXX failed to follow code 455.17 in reporting any and all adverse actions of credible allegations of fraud.
XXX failed to follow code 455.18 by not reporting any overpayments or claims related to credible allegation of fraud.
XXX failed to respond to any request that was made pertaining to documentation of reports, investigations, onsite visits etc. made by XXXX in XXX.
- XXXX
XXX works for the XXX Health Care Authority (OHCA)-Position-Deputy Chief Executive Officer. XXX was in attendance of the Post Termination Panel Hearing as a member of the panel for XXX Companies. Ms. XXX failed to adhere to the federal code of regulations during the post-termination hearing by not following administrative procedures of due process. XXX position with the OHCA allowed her to be familiar with and adhere to the policies and procedures of a provider before the termination of a contract and thereafter. XXX utilized the 70-page findings report that included the referral of credible allegations of fraud presented on the behalf of the OHCA and the information on the letter of termination of XXX contracts to help determine her final decision. The findings report included no audit report and an incomplete referral process that only presented one of Briggs’s companies. The letter of termination included that the only procedure hearing that Plaintiff was allowed was (OAC) code 317:2-12 (3), although the decision of the panel hearing letter had the statement that Plaintiff was entitled to an administrative review; there was not one given nor offered before the termination or after. There were no other appeals or administrative procedures ever offered after the panel hearing’s decision on XXX was a decision-maker on continuing to terminate Plaintiff’s contracts based solely on the five employees’ statements. As one of the five-panel hearing members, XXX contested in signing on the panel termination letter that Ms. Briggs-Wrenn Sooner-Care contracts were properly terminated and the OHCA complied with the requirements of federal regulations. XXX made her decision without Plaintiff having a procedural due process which was presented in the panel hearing report. (42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
See Exhibits 1-Outcome Panel Hearing Letter; Exhibit 2-Panel Hearing Transcript; Exhibit 3-OHCA Referral Findings Report; Exhibit 3-OHCA Policy and Procedure Manual; and Exhibit 4-CMS Guidelines.
- XXX
XXX worked for Oklahoma Health Care Authority (OHCA)-Position-Chief Operating Officer. XXX was in attendance of the Post Termination Panel Hearing as a member of the panel for Briggs Companies. XXX failed to adhere to the federal code of regulations during the post-termination hearing by not following administrative procedures of due process. XXX position with the OHCA allowed her to be familiar with and adhere to the policies and procedures of a provider before the termination of a contract and thereafter. XXX utilized the 70-page findings report that included the referral of credible allegations of fraud presented on the behalf of the OHCA and the information on the letter of termination of Briggs contracts to help determine her final decision. The findings report included no audit report and an incomplete referral process that only presented one of Briggs’s companies. The letter of termination included that the only procedure hearing that Plaintiff was allowed was (OAC) code 317:2-12 (3), although the decision of the panel hearing letter had the statement that Plaintiff was entitled to an administrative review; there was not one given nor offered before the termination or after. There were no other appeals or administrative procedures ever offered after the panel hearing’s decision on XXX was a decision-maker on continuing to terminate Plaintiff’s contracts based solely on the five employees’ statements. As one of the five-panel hearing members, XXX contested in signing on the panel termination letter that XXX Sooner-Care contracts were properly terminated and the OHCA complied with the requirements of federal regulations. XXX made her decision without Plaintiff having a procedural due process from 42 CFR-455.13-45 which was presented in the panel hearing report. (42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
See Exhibits 1-Outcome Panel Hearing Letter; Exhibit 2-Panel Hearing Transcript; Exhibit 3-OHCA Referral Findings Report; Exhibit 3-OHCA Policy and Procedure Manual; and Exhibit 4-CMS Guidelines.
- XXX
XXX worked for Department of Mental Health and Substance Abuse Services as Director of Program Enhancement. XXX was in attendance of the Post Termination Panel Hearing as a member of the panel for Briggs Companies. XXX failed to adhere to the federal code of regulations during the post-termination hearing by not following administrative procedures of due process. XXX position with the OHCA allowed her to be familiar with and adhere to the policies and procedures of a provider before the termination of a contract and thereafter. Ms. Larsen utilized the 70-page findings report that included the referral of credible allegations of fraud presented on the behalf of the OHCA and the information on the letter of termination of Plaintiff’s contracts to help determine her final decision. The findings report included no audit report and an incomplete referral process that only presented one of Briggs’s companies. The letter of termination included that the only procedure hearing that Plaintiff was allowed was (OAC) code 317:2-12 (3), although the decision of the panel hearing letter had the statement that Plaintiff was entitled to an administrative review; there was not one given nor offered before the termination or after. There were no other appeals or administrative procedures ever offered after the panel hearing’s decision on XXX.XXX was a decision-maker on continuing to terminate Plaintiff’s contracts based solely on the five employees’ statements. As one of the five-panel hearing members, XXX contested in signing on the panel termination letter that XXX -Wrenn Sooner-Care contracts were properly terminated and the OHCA complied with the requirements of federal regulations. XXX made her decision without Plaintiff having a procedural due process from 42 CFR-455.13-45 which was presented in the panel hearing report. (42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
See Exhibits 1-Outcome Panel Hearing Letter; Exhibit 2-Panel Hearing Transcript; Exhibit 3-OHCA Referral Findings Report; Exhibit 3-OHCA Policy and Procedure Manual; and Exhibit 4-CMS Guidelines.
- XXX
XXX Rains works for Department of Mental Health and Substance Abuse Services as senior director/policy and provider regulation. XXX was in attendance of the Post Termination Panel as a member of the panel for Briggs Companies. XXX failed to adhere to the federal code of regulations during the post-termination hearing by not following administrative procedures of due process. XXX position with the OHCA allowed her to be familiar with and adhere to the policies and procedures of a provider before the termination of a contract and thereafter. Mr. Rains utilized the 70-page findings report that included the referral of credible allegations of fraud presented on the behalf of the OHCA and the information on the letter of termination of Briggs contracts to help determine her final decision. The findings report included no audit report and an incomplete referral process that only presented one of Briggs’s companies. The letter of termination included that the only procedure hearing that Plaintiff was allowed was (OAC) code 317:2-12 (3), although the decision of the panel hearing letter had the statement that Ms. Briggs was entitled to an administrative review; there was not one given nor offered before the termination or after. There were no other appeals or administrative procedures ever offered after the panel hearing’s decision on XXX. XXX was a decision-maker on continuing to terminate Plaintiff’s contracts based solely on the five employees’ statements. As one of the five-panel hearing members, XXX contested in signing on the panel termination letter that XXX Sooner-Care contracts were properly terminated and the OHCA complied with the requirements of federal regulations. XXX made her decision without Plaintiff having a procedural due process which was presented in the panel hearing report. (42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
See Exhibits 1-Outcome Panel Hearing Letter; Exhibit 2-Panel Hearing Transcript; Exhibit 3-OHCA Referral Findings Report; Exhibit 3-OHCA Policy and Procedure Manual; and Exhibit 4-CMS Guidelines.
- XXX
XXX works for the Oklahoma Health Care Authority (OHCA)-Position- Assistant Director of Policy. XXX was in attendance of the Post Termination Panel Hearing as a member of the panel for Briggs Companies. XXX failed to adhere to the federal code of regulations during the post-termination hearing by not following administrative procedures of due process. XXX position with the OHCA allowed her to be familiar with and adhere to the policies and procedures of a provider before the termination of a contract and thereafter. XXX utilized the 70-page findings report that included the referral of credible allegations of fraud presented on the behalf of the OHCA and the information on the letter of termination of Briggs contracts to help determine her final decision. The findings report included no audit report and an incomplete referral process that only presented one of Briggs’s companies. The letter of termination included that the only procedure hearing that Plaintiff was allowed was (OAC) code 317:2-12 (3), although the decision of the panel hearing letter had the statement that Plaintiff was entitled to an administrative review; there was not one given nor offered before the termination or after. There were no other appeals or administrative procedures ever offered after the panel hearing’s decision on XXXX. XXX was a decision-maker on continuing to terminate Ms. Briggs’s contracts based solely on the five employees’ statements. As one of the five-panel hearing members. XXX contested in signing on the panel termination letter that Ms. Briggs-Wrenn Sooner-Care contracts were properly terminated and the OHCA complied with the requirements of federal regulations. XXX made her decision without Plaintiff having a procedural due process from 42 CFR-455.13-45 which was presented in the panel hearing report. (42 CFR 455.13-Methods for identification, investigation and referral, 455.14-Preliminary Investigation, 455.17-Reporting Requirement, 455.18-Providers Statements or Claims Forms, 455.20-Beneficiary Verification Procedure 455.23-Suspension of Payments In cases of Fraud. Termination letter was sent under his guidance, direction, and authorization.
See Exhibits 1-Outcome Panel Hearing Letter; Exhibit 2-Panel Hearing Transcript; Exhibit 3-OHCA Referral Findings Report; Exhibit 3-OHCA Policy and Procedure Manual; and Exhibit 4-CMS Guidelines.
- XXX DIRECTOR
XXX works as an attorney for the Medicaid Fraud Control Unit and Assistant Attorney General-Job Duties-Deputy Chief Executive Officer. Job duties
See Exhibit 1-MFCU chart; Exhibit 2-Medicaid Payment Suspension Toolkit; Exhibit 3-CMS Guidelines; Exhibit 4-MFCU policy and procedures. Exhibit 5- Probable Cause Affidavit; Exhibit 6-Motion Hearing Transcripts; Exhibit 7- Preliminary Hearing Transcripts (included in initial filing); Exhibit 8-Referral from OHCA; Exhibit 9-Deferred Prosecution Agreement; and Exhibit 10-2014 Onsite Review from OIG.
XXX failed upon receiving referral on XXX, Fry accepted a referral from XXX (OHCA employee) with incomplete referral requirements that is according to 42 CFR 455.13-Methodolgy. The referral was also sent over to the MFCU with only one of Briggs companies (Briggs Therapeutic CDC out of four of XXX companies). Plaintiff owned four companies with four separate provider contracts.
XXX continued an investigation of Plaintiff without procedural due process from the XXX Health Care Authority upon receiving the complaint and or referrals from XXX and XXXX. Agent XXX as the Director of the MFCU aided and embedded XXX to falsify that there was an audit conducted on Briggs Companies in the probable cause affidavit for filing of charges; thereafter she admitted several motion hearings that there was not an audit conducted on Briggs companies and the Wrenn’s issue with due process needs to be taken up in civil court.
XXX failed to complete a full investigation 42 CFR 455.15 upon receiving the referral from XXX after XXX. XXX was not able to complete a full investigation and never supplied one by request from a motion for discovery based on several causes. 1) The MFCU must receive a preliminary investigation of due process from state agency to warrant a full investigation according 42 CFR 455.14. XXX as demonstrated in the motion hearing reports, continues to deny identifying any overpayment claims of the credible allegations of fraud of filed charges of Janice Wrenn, Briggs Companies or Options Unlimited.
XXX failed to complete resolution of full investigation 42 CFR 455.16. Ms. Fry never presented any overpayments or recovery of payments to XXXX Companies or Options Unlimited overpayments prior to filing of charges XXX. The case was never closed or was dropped due to insufficient evidence to support the allegations of fraud.
XXX failed to report all adverse actions as required to the Office of Inspector General according to procedure 42 CRF 455. 17-Reporting requirements. According to state responses to motion to compel hearing; there was never any reporting conducted by the state to the CMS or OIG.
XXX failed to suspend coordinate suspension of payments with the state agency (Oklahoma Health Care Authority) when receiving complaints and/or referrals for Briggs Companies and Options Unlimited.
XXX failed to suspend and coordinate suspension of payment with the state agency (Oklahoma Health Care Authority) and Options Unlimited when or if billing became questionable upon receiving complaints from OHCA.
OHCA has never had any mentioning in Briggs Companies termination letter, panel hearing, Kimberly Shoals (provider of Options Unlimited) nor any state witnesses at the preliminary hearing that false claims were billed under Briggs Companies provider numbers nor Options Unlimited Provider numbers. Yet the state mentions in the probable cause of affidavit, preliminary hearing and their motion responses in state court that claims submitted before and after Brigg’s termination was fraudulent and falsely labeled as Options claims. Plaintiff has yet to receive any overpayment of claims from the Oklahoma Health Care Authority or MFCU to support allegations of Fraud. Plaintiff has only received payment amounts from the Attorney Generals Probable Cause Affidavit and never presented in any previous discovery material or requests from Plaintiff in state courts.
XXX is aware of procedural due process with Oklahoma Health Care Authority based on Options Unlimited receiving an audit XXX, and Ms. Kimberly Shoals following up with recovery of payments after audit was conducted. These claims were presented within the audit findings report and recovered payments paid directly to the OHCA legal division. The MFCU has never responded to any of the Plaintiff’s request for the mentioning of recovery of payments that was paid by Ms. Kimberly Shoals (provider of Options Unlimited) that was directed on the deferred prosecution agreement.
When the Plaintiff expressed a verbal and written complaint regarding failure of procedural due process conducted on behalf of the Oklahoma Health Care Authority and the MFCU. Ms. Fry ignored the complaint and did not take any further action afterwards.
- XXX-MFCU INVESTIGATOR
XXX works as an Agent for the Medicaid Fraud Control Unit Job Duties-Investigating allegations of fraud and abuse by providers and facilities receiving Medicaid funds.
XXX failed upon receiving referral on XXX, XXX (Director of MFCU) accepted a referral from XXX (OHCA employee) with incomplete referral requirements that is according to 42 CFR 455.13-Methodolgy. The referral was also sent over to the MFCU with only one of Briggs companies (Briggs Therapeutic CDC out of four of Ms. Briggs companies). Plaintiff owned four companies with four separate provider contracts.
XXX investigation never demonstrated nor concluded that there were indicia of reliability (42 CFR 405.370) to support any credible allegations of fraud from Plaintiff, Briggs Companies and Options Unlimited before or after the filing of charges.
XXX continued with an investigation of Plaintiff without procedural due process from the XXX Health Care Authority upon receiving the complaint and or referrals from Travis Kirkpatrick and XXX. Agent XXX falsified a statement in the probable cause affidavit that there was an audit conducted on Briggs Companies, and there was fraud found in the audit. In several motion hearings that took place in XXX, the state admitted that there was not an audit conducted on XXX companies.
XXX failed to complete a full investigation 42 CFR 455.15 upon receiving the referral from XXX after XXX was not able to complete a full investigation and never supplied one by request from a motion for discovery based on several causes. 1) The MFCU must receive a preliminary investigation of due process from state agency to warrant a full investigation according 42 CFR 455.14. XXX as demonstrated in the preliminary hearing reports, continues to deny identifying any overpayment claims of the credible allegations of fraud in filed charges of Plaintiff, Briggs Companies or Options Unlimited.
XXX failed to complete resolution of full investigation 42 CFR 455.16. Ms. Fry never presented any overpayments or recovery of payments to Plaintiff or Briggs Companies or Options Unlimited overpayments prior to filing of charges June 20, 2016. The case was never closed or was dropped due to insufficient evidence to support the allegations of fraud.
XXX failed to report all adverse actions as required to the Office of Inspector General according to procedure 42 CRF 455. 17-Reporting requirements. According to state responses to motion to compel hearing; there was never any reporting conducted by the state to the CMS or OIG.
XXX failed to suspend coordinate suspension of payments with the state agency (Oklahoma Health Care Authority) when receiving complaints and/or referrals for Briggs Companies and Options Unlimited.
XXX failed to suspend and coordinate suspension of payment with the state agency (Oklahoma Health Care Authority) and Options Unlimited when or if billing became questionable upon receiving complaints from OHCA.
XXX is aware of procedural due process with Oklahoma Health Care Authority based on Options Unlimited receiving an audit June 2013, and Ms. Kimberly Shoals following up with recovery of payments after audit was conducted. These claims were presented within the audit findings report and recovered payments paid directly to the OHCA legal division. The MFCU has never responded to any of the Plaintiff’s request for the mentioning of recovery of payments that was paid by Ms. Kimberly Shoals (provider of Options Unlimited) that was directed on the deferred prosecution agreement.
When the Plaintiff expressed a verbal and written complaint regarding failure of procedural due process conducted on behalf of the Oklahoma Health Care Authority and the MFCU. Ms. Fry ignored the complaint and did not take any further action afterwards.
See Exhibit 1-MFCU chart; Exhibit 2-Medicaid Payment Suspension Toolkit; Exhibit 3-CMS Guidelines; Exhibit 4-MFCU policy and procedures.; Exhibit 5- Probable Cause Affidavit; Exhibit 6-Cover pages; Exhibit 7-Motion Hearing Transcripts; Exhibit 8-Referral from OHCA; Exhibit 9-Deferred Prosecution Agreement; Exhibit 10-2014 Onsite Review from OIG; and Exhibit 11-Letter to U.S Attorney.
- SCOTT PRUITT-PRIOR ATTORNEY GENERAL
Scott Pruitt worked as Attorney General for the state of Oklahoma from XXX. Job duties include providing legal advice and representation in court for the Governor and the state government in general, providing legal advice, official opinions, to the governor and members of the legislature, defending the state in cases of criminal appeals and suits against the state, and defending the constitutionality of state laws.
Mr. Pruitt’s office failed to enforce the laws that was mandated by the legislative body and the house of representatives.
Mr. Pruitt’s office failed to defend plaintiff when they saw that their constitutional rights violated with Oklahoma Health Care Authority.
The AGs did not comply to federal laws and regulations relative the operations of a Medicaid Fraud Unit. The AG proceeded to represent the MFCU and OHCA with Plaintiffs violations of due process. Plaintiff previous Briggs was never given due process prior to filing of charges. And continued to establish in court that Plaintiff’s preliminary hearing was her due process as stated in the motions.
Mr. Pruitt failed to abide by the Medicaid Fraud False Claims Act by not substantiated any victim of fraud and claims that was related to Oklahoma Health Care Authority and MFCU allegations of fraud. Mr. Pruitt’s office continued to investigate Plaintiff with Medicaid Fraud as a provider after the termination of her contracts as a provider May 16, 2013.
Mr. Pruitt AG assistant Lory Dewey demonstrated in emails that she was unlawfully investigating Plaintiff facilities after the issue was resolved with DHS called in a complaint. Plaintiff resolved this matter with her Attorney of the misunderstanding with her previous held Daycare license that was terminated prior to her beginning her day treatment services. Ms. Dewey emails that were demonstrated in discovery demonstrates harassment and intimidation by contacting XXX with Oklahoma Health Care Authority to look at billing patterns after Department of Human Services called in a complaint of confusion about the services Plaintiff was offering. XXXX now works for the AG office and has become one of their state witnesses.
See Exhibit 1-Probable Cause Affidavit; Exhibit 2-OHCA Referral; and Exhibit 3- Kimberly Shoals Recordings to OHCA.
- MIKE HUNTER-CURRENT ATTORNEY GENERAL
Mike Hunter works as entered in office as Attorney General of Oklahoma beginning February 20, 2017-Present. Job duties include providing legal advice and representation in court for the Governor and the state government in general, providing legal advice, official opinions, to the governor and members of the legislature, defending the state in cases of criminal appeals and suits against the state, and defending the constitutionality of state laws.
Mr. Hunter’s office failed to enforce the laws that was mandated by the legislative body and the house of representatives.
Mr. Hunter’s office failed to defend plaintiff when they saw that their constitutional rights violated with Oklahoma Health Care Authority.
The AGs did not comply to federal laws and regulations relative the operations of a Medicaid Fraud Unit. The AG proceeded to represent the MFCU and OHCA with Plaintiffs violations of due process. Plaintiff previous Briggs was never given due process prior to filing of charges. And continued to establish in court that Plaintiff preliminary hearing was her due process as stated in the motions.
Mr. Hunter’s failed to abide by the Medicaid Fraud False Claims Act by not substantiated any victim of fraud and claims that was related to Oklahoma Health Care Authority and MFCU allegations of fraud. Mr. Pruitt’s office continued to investigate Plaintiff with Medicaid Fraud as a provider after the termination of her contracts as a provider May 16, 2013.
Mr. Hunter’s AG assistant Lory Dewey demonstrated in emails that she was unlawfully investigating Ms. Brigg facilities after the issue was resolved with DHS called in a complaint. Plaintiff resolved this matter with her Attorney of the misunderstanding with her previous held Daycare license that was terminated prior to her beginning her day treatment services. Ms. Dewey emails that were demonstrated in discovery demonstrates harassment and intimidation by contacting XXX with Oklahoma Health Care Authority to look at billing patterns after Department of Human Services called in a complaint of confusion about the services Plaintiff was offering. XXX now works for the AG office and has become one of their state witnesses.
See Exhibit 1-Motion Hearing Transcripts; Exhibit 2-State Responses to the Previous Filed Motions; Exhibit 3-Preliminary Hearing Transcripts (included in initial filing); Exhibit 4- Recording from XXX; Exhibit 5-Email from XXX; and Exhibit 6-Letter to U.S Attorney.
- XXX ASSISTANT ATTORNEY GENERAL
XXX works as the Assistant Attorney General in the state of XXX. The Legal Counsel Unit provides legal advice and representation to state agencies, boards, and commissions on a daily basis. This representation includes advising agencies concerning the lawful discharge of their duties and powers; representing agencies in administrative proceedings, employment proceedings and some civil and appellate litigation; prosecuting holders of professional licenses before Boards that grant said licenses. The Assistant Attorney General in this position will appear in state and appellate courts as well as adjudicative hearings before various agencies and state bodies. The Assistant Attorney General will effectively and professionally research, prepare, analyze, and understand complex information.
XXX failed to enforce the laws that was mandated by the legislative body and the house of representatives.
XXX failed to defend plaintiff when they saw that their constitutional rights violated with XXX Health Care Authority.
The AGs did not comply to federal laws and regulations relative the operations of a Medicaid Fraud Unit. The AG proceeded to represent the MFCU and OHCA with Plaintiffs violations of due process. Plaintiff previous Briggs was never given due process prior to filing of charges. And continued to establish in court that Plaintiff preliminary hearing was her due process as stated in the motions.
XXX failed to abide by the Medicaid Fraud False Claims Act by not substantiated any victim of fraud and claims that was related to XXX Health Care Authority and MFCU allegations of fraud. Mr. Pruitt’s office continued to investigate Plaintiff with Medicaid Fraud as a provider after the termination of her contracts as a provider XXX.
XXX demonstrated in emails that she was unlawfully investigating Plaintiff facilities after the issue was resolved with DHS called in a complaint. Plaintiff resolved this matter with her Attorney of the misunderstanding with her previous held Daycare license that was terminated prior to her beginning her day treatment services. Ms. Dewey emails that were demonstrated in discovery demonstrates harassment and intimidation by contacting XXX with Oklahoma Health Care Authority to look at billing patterns after Department of Human Services called in a complaint of confusion about the services Plaintiff was offering. XXX now works for the AG office and has become one of their state witnesses.
See Exhibit 1-Motion Hearing Transcripts; Exhibit 2-State Responses to the Previous Filed Motions; Exhibit 3-Preliminary Hearing Transcripts (included in initial filing); Exhibit 4- Recording from Kimberly Shoals; Exhibit 5-Email from Etchinson; and Exhibit 6-Letter to U.S Attorney.
XXX failed to protect our civil rights when she saw there was no audit, preliminary investigation given from the state agency (XXX Health Care Authority).
CONCLUSION
For the reasons detailed above, Plaintiff vehemently opposes Defendants’ Motion to Dismiss and prays this honorable court to deny and dismiss it in toto.
Respectfully submitted,
DATED:
CERTIFICATE OF MAILING
IXXX certified on this day of .XXX, I deposited a true copy of the above to the defendant by placing the documents with prepaid postage in the XXX mailbox address to each person.
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