Dr. Behzad Nazari, D.D.S. v. State
Dr. Behzad Nazari, D.D.S. v. State
Opinion
In this enforcement action under the Texas Medicaid Fraud Prevention Act (the Act), the State of Texas alleges that several dentists and their professional associations and employees (collectively, the Providers) fraudulently obtained Medicaid payments for providing dental and orthodontic treatments to children. In response, the Providers assert counterclaims and third-party claims alleging that the state and its contractor mismanaged the payment-approval process and misled the Providers regarding the requirements that the Texas Medicaid Program (the Program) imposes. The state filed a plea to the jurisdiction against the counterclaims and a motion to dismiss the third-party claims. The trial court granted both. The Providers filed this interlocutory appeal. We conclude that sovereign immunity bars the Providers' counterclaims against the state and that we lack interlocutory jurisdiction to address the trial court's dismissal of the Providers' third-party claims. We affirm the court of appeals' judgment.
I
Background
The facts giving rise to this dispute depend on whom you ask. According to the state, the Providers voluntarily agreed to participate in the Program by providing
orthodontic treatments to qualifying children in exchange for payments from the state at reduced Medicaid rates.
1
See generally
The Providers tell a different story. They deny knowingly submitting false prior-authorization or payment requests. Instead, they claim their requests and services complied with the Program's requirements as the state and Xerox explained and enforced those requirements. According to the Providers, the state permitted and even intended Xerox to approve as many treatments as possible. This instruction, the Providers say, was part of the state's plan to fend off additional liabilities in a series of long-running federal lawsuits related to allegations that the Program "did not satisfy the requirements of federal law."
Frew ex rel. Frew v. Hawkins
,
The Providers allege that because the state was desperate to appear compliant with the federal-court orders, the state turned a blind eye to Xerox's routine rubber-stamping of the Providers' requests. This, the Providers say, led them to believe that the information they were submitting complied with the Program's requirements and established that their patients qualified for orthodontic services. But when reports of the state's exploding expenditures began to emerge, the Providers allege the state blamed them in an effort to avoid responsibility for its own actions, enrich itself, and limit its liability to the federal government for having mismanaged the Program. As a result, the Providers say they are not responsible for improper requests, if any, and are not liable for any overpayments. To the contrary, urge the Providers, the state and Xerox are liable for all losses, expenses, and attorney's fees that the Providers have incurred as a result of the state's and Xerox's "scheme."
The state's first step was to initiate administrative actions against various dentists-including the Providers-alleging they fraudulently obtained payments from the Program. An avalanche of legal proceedings involving the state, Xerox, and the Providers ensued. Throughout these proceedings, the state has sought to pursue its claims against Xerox and the Providers separately, while Xerox and the Providers have attempted, unsuccessfully, to join all of the claims in one proceeding. After the administrative-law judges ruled against the state in its administrative actions, the state filed this lawsuit against the Providers.
In this suit, the state alleges that the Providers committed fraud in violation of the Act by submitting false prior-authorization and payment requests, seeking payments for services never rendered, misrepresenting the qualifications of those who provided orthodontic services, and, in some cases, accepting illegal kickbacks. The state argued that the trial court could enjoin the Providers from committing fraud. See TEX. HUM. RES. CODE § 36.051(a) (authorizing injunctive relief). It also pleaded in its petition for a recovery "to the maximum extent allowed by law," including specifically:
The state's live petition alleges that the Providers fraudulently performed "general dental and/or orthodontic services." The remainder of this opinion refers to these services as "orthodontic services" or "orthodontic treatments."
The state's allegations against Xerox form the core of a separate Medicaid-fraud case, also announced today.
See
In re Xerox
,
(1) the amount of any payments provided under the [Program], directly or indirectly, as a result of each [Provider's] unlawful acts,
(2) prejudgment interest on the amount of the payments or the value of such payments,
(3) two times the amount of any payment provided under the [Program], directly or indirectly, as a result of each [Provider's] unlawful acts,
(4) civil penalties, and
(5) expenses, costs, and attorneys' fees.
See
The Providers filed an answer generally denying the state's allegations. They also asserted counterclaims against the state for conspiracy, breach of contract, and conversion. The Providers seek "proportional recovery of actual and exemplary damages, interest, court costs, and attorney's fees against the State." They allege that the state has waived its sovereign immunity as to the Providers' "connected, germane, and defensive counterclaims" and that it "is liable up to those amounts plead[ed]." The Providers also asserted third-party claims against Xerox, seeking damages and contribution for common-law fraud, breach of contract, promissory estoppel, negligent hiring, negligent supervision, negligence, and gross negligence. They allege the state and Xerox were responsible for authorizing the Providers' services and conspired to rubber-stamp the Providers' authorization and payment requests. The Providers say this conspiracy led them to continue using the same standards to establish medical necessity, making the state and Xerox liable for any payments for services that were not medically necessary.
The state filed a plea to the jurisdiction against the Providers' counterclaims, asserting that sovereign immunity bars the counterclaims and that the Providers lack
standing to assert any claims under the Act or for breach of the contract between the state and Xerox. The state also filed a motion to dismiss the Providers' third-party claims against Xerox, arguing that the Act does not permit a defendant to assert third-party claims and that sovereign immunity bars such claims against a state contractor acting within the scope of its contractual authority. The trial court granted both motions, expressly holding that "the state is entitled to bring this action against [the Providers] to the exclusion of other parties." The Providers filed an interlocutory appeal, and Xerox filed a brief supporting the Providers' appeal. The court of appeals affirmed the trial court's order dismissing the Providers' counterclaims.
We granted the Providers' petition for review. We need not and do not address the merits of the parties' claims or pick between their competing descriptions of the underlying facts. The only issues before us today are: (1) whether sovereign immunity bars the Providers' counterclaims against the state; and (2) whether the trial court erred by dismissing the Providers' third-party claims against Xerox. We conclude that sovereign immunity bars the counterclaims, and we agree with the court of appeals that we lack interlocutory jurisdiction to address the order dismissing the third-party claims.
II
Counterclaims
The trial court dismissed the Providers' counterclaims on the ground that sovereign immunity bars those claims, meaning the court lacked jurisdiction to hear them. The common-law doctrine of sovereign immunity prohibits suits against the state unless the state consents and waives its immunity.
See
Hall v. McRaven
,
Although the state may elect to waive its sovereign immunity, that policy decision belongs largely to the legislature.
See
Engelman
,
The Providers argue that the attorney general "waived" the state's sovereign immunity
by filing this suit and voluntarily appearing in court. In support, the Providers rely on cases like
Anderson, Clayton & Co. v. State ex rel. Allred
, in which we held that "where a state voluntarily files a suit and submits its rights for judicial determination, it will be bound thereby, and the defense will be entitled to plead and prove all matters properly defensive."
The state disagrees, relying on cases like
Borden v. Houston
for the rule that the state's appearance as a plaintiff in its own courts does not waive its immunity against counterclaims.
See
We agree with the state that these decisions do not establish that the state
waives
its sovereign immunity by initiating suit. Many of the cases the Providers cite stand simply for the proposition that procedural rules apply to the state just as they would to any other litigant when the state appears in court. That proposition, though sound, does not answer the question whether sovereign immunity protects the state from having to defend certain actions to begin with.
See
Fed. Sign
,
And while the quote from
Anderson
appears to support the Providers' waiver argument, we clarified that case and others like it in
Reata Construction Corp. v. City of Dallas
.
See
197 S.W.3d at 374, 376-77 (citing
Anderson
,
At issue here, then, is not whether the state waived its immunity against the Providers' counterclaims by filing this suit, but whether the scope of the state's immunity encompasses those counterclaims to begin with.
See
Albert
,
To resolve the issue, we must first answer which part of the phrase "monetary damages" best captures
Reata
's holding: is it the word "monetary," as the Providers argue, or is it the word "damages," as the state argues?
See
id.
at 375. We conclude that
Reata
applies to damages, but that the question whether it applies further-and how much-is one of first impression. This conclusion gives rise to a second question: does
Reata
apply to penalties? We conclude that it does not. The third question is whether the state's action under the Act seeks to impose a penalty. We answer that question in
Xerox
, also decided today.
See
Xerox
,
A
The Providers argue that Reata applies broadly: anytime the state seeks a transfer of funds. They contend that we have given "broad application" to the rule waiving sovereign immunity when the state files a suit "in the form of affirmative claims for monetary relief." Thus, the Providers argue, " Reata simply does not contemplate or support a distinction between damages and penalties" and "the [court of appeals] was wrong to create one." The Act authorizes (and the state has pleaded for) a monetary award including: (1) the amount of any payment the state made as a result of each unlawful act, (2) prejudgment interest on that amount, (3) a civil penalty for each unlawful act, and (4) two times the amount of any payment made as a result of an unlawful act. See TEX. HUM. RES. CODE § 36.052(a). The Providers argue that although Reata happened to involve tort claims for compensatory damages, we did not limit our holding to only those types of claims seeking only that type of monetary relief. See, e.g. , 197 S.W.3d at 376-78 (referring three times to the governmental entity's claims for "monetary relief"); id. at 377 ("Once it asserts affirmative claims for monetary recovery , the City must participate in the litigation process as an ordinary litigant[ ] ...." (emphasis added) ); id. at 375 ("If the opposing party's claims can operate only as an offset to reduce the government's recovery , no tax resources will be called upon to pay a judgment[ ] ...." (emphasis added) ).
The state responds that Reata applies narrowly: only when the state seeks compensatory damages. Since Reata referred to the City's claim as "damages," the state says that damages are the only type of relief that Reata addressed. See id. at 377 ("[The City's decision] to file suit for damages encompassed a decision to leave its sphere of immunity from suit for claims against it which are germane to, connected with and properly defensive to claims the City asserts." (emphasis added) ); id. ("[T]he trial court acquired subject-matter jurisdiction over claims made against the City which were connected to, germane to, and properly defensive to the matters on which the City based its claim for damages ." (emphasis added) ); id. ("[T]he trial court did not acquire jurisdiction over a claim for damages against the City in excess of damages sufficient to offset the City's recovery, if any." (emphasis added) ); id. ("[T]he City's assertion of claims for damages against Reata means that the City does not have immunity from Reata's claims to the limited extent we have explained ...." (emphasis added) ).
We do not agree with either party's characterization of our precedent. In Reata and its progeny, we used broad terms like "monetary relief" simply to refer to the damages the government sought. That usage does not establish that Reata applies to all money claims, as the Providers suggest. But neither does it expressly limit the Reata rule to compensatory damages, as the state suggests. In other words, the issue whether the Reata rule covers the facts this case presents is one of first impression.
1. Pre- Reata decisions
Reata
's abrogation analysis cites eight cases, but it discusses only three of them in depth.
See
197 S.W.3d at 376-77. Two cases appear only once each.
See id.
(first citing
Tex. Nat. Res. Conservation Comm'n v. IT-Davy
,
The first of the three principal cases on which
Reata
relied,
Anderson
, was an enforcement action in which the state sought "recovery of penalties" against a trucking company that was operating without a license.
Anderson
,
The state having invoked the jurisdiction of the district court ... for a judicial determination of the question as to whether the defendants were ... liable for the penalties ... became subject to the same rules as other litigants, except in so far as such rules may be modified in favor of the state by statute or may be inapplicable or unenforceable because of exemptions inherent in sovereignty.
The second case,
State v. Humble Oil & Refining Co.
, involved an operator that overpaid taxes in some months but underpaid them in another.
See
We have no fault to find with the rule of law announced in the Anderson, Clayton & Co. opinion, when applied in a proper case. It, however, can have no application in this suit, because to here apply it would allow it to abolish the rule that taxes due the State cannot be offset by an indebtedness due by the State to the tax debtor. Furthermore, here we have no offset claim which is dependent upon, connected with, or grew out of the subject matter of this suit. It is true that the subject matter of this suit is gross production taxes on oil, and the subject matter of the offset claim is the same character of taxes. But the one claim has no connection with the other, and the two claims are entirely independent of each other .... The two claims are not even involved in the same report.
Id.
at 709-10 (emphasis added).
Humble Oil
thus recognized something that
Anderson
itself did not-that the "rule of law announced" in
Anderson
could apply to some monetary offsets.
Id.
at 709 ;
see also
Anderson
,
The third case,
Kinnear v. Texas Commission on Human Rights ex rel. Hale
, addressed a counterclaim for attorney's fees in response to the state's initiation of
a suit under the Texas Fair Housing Act.
See
In sum, of the three cases on which
Reata
grounded its analysis, the first did not even involve a counterclaim for money,
see
Anderson
,
2. Reata
In Reata , a contractor sued a subcontractor, alleging that the subcontractor negligently drilled into a water main. See 197 S.W.3d at 373. The subcontractor filed a third-party claim against the City of Dallas. See id. Before answering the subcontractor's third-party claim, the City intervened and "assert[ed] claims of negligence against [the subcontractor] and a plea to the jurisdiction asserting governmental immunity from suit." Id. (emphasis added). That is, the City sought to recover for the subcontractor's negligence, and at the same time maintained that it was immune from answering for its own negligence. See id. We announced, in Reata 's introductory paragraph, that "the City does not have immunity from suit as to [the subcontractor's] claims which are germane to, connected with, and properly defensive to the City's claims, to the extent [the subcontractor's] claims offset those asserted by the City." Id. The remainder of the opinion confirms that our decision regarding the City's claims resulted from the claims' character as damages rather than their character as money . See generally id. at 374-77.
First,
Reata
uses the word "damages" more than a dozen times. By contrast, it refers but three times to the City's "recovery," twice to its claims for "monetary relief," and only once to a "monetary recovery."
See
id.
at 373-78. This usage indicates that we decided the case based on the narrow theory of damages rather than the broad theory of a transfer of funds.
See
id.
at 375 ("The United States Supreme Court has also recognized that suits for money
damages
against states 'may threaten the financial integrity of the States' and that 'at the time of the founding, many of the States could have been forced into insolvency but for their immunity from private suits for
money damages
.' " (emphasis added) (quoting
Alden v. Maine
,
Second, accepting the interpretation the Providers urge-that
Reata
applies "without regard to the type of monetary relief" sought-would require us to accept that
Reata
overruled
Humble Oil
sub silentio. Because if the
Reata
rule applies to every "monetary recovery,"
see
197 S.W.3d at 377, then the
Reata
rule applies anytime the state sues to collect taxes. But
Humble Oil
holds precisely the opposite.
See
Third, if Reata abrogated immunity for some class of cases beyond damages, why is "monetary recovery" the limit rather than "recovery" in general or simply "any claim"-monetary or otherwise? See, e.g. , 197 S.W.3d at 375-76 ("In this situation, we believe it would be fundamentally unfair to allow a governmental entity to assert affirmative claims against a party while claiming it had immunity as to the party's claims against it." (emphasis added) ); id. at 376 ("[W]hen an affirmative claim for relief is filed by a governmental entity, subsequent cases indicate that under such circumstances immunity from suit no longer completely exists for the governmental entity." (emphasis added) ). Since the Providers' interpretation offers no upper limit on Reata 's ambit, we decline to adopt it. Though subsequent cases may modify, expand, or clarify its scope, in Reata itself the abrogation-of-immunity rule applied only to the City's claim for damages.
Moreover, our decisions following
Reata
also support the conclusion that the
Reata
rule applies to some, though not necessarily all, monetary claims. For example, in
City of Dallas v. Albert
, we characterized our decision in
Reata
as one "conclud[ing] that immunity from suit was abrogated to a
limited
degree."
These considerations convince us that the state's assertion of a claim for monetary relief, standing by itself, is not enough to trigger Reata 's abrogation-of-immunity rule. Said otherwise, the fact that the state seeks a transfer of funds is not sufficient to place it beyond the protections that immunity from suit affords. When it asserts an affirmative claim for damages, the state steps outside the sphere of its immunity from suit to the extent we described in Reata . See 197 S.W.3d at 375-76. But money is at issue in many more of the state's actions than those in which it seeks damages.
B
Having concluded that the Reata rule does not abrogate sovereign immunity in every suit in which the state seeks a transfer of funds, we must next consider whether the Reata rule applies to the action at issue in this case. Contrary to the Providers' argument, we have never held that the Reata rule always applies when the government seeks any transfer of funds. And contrary to the state's suggestion, nor have we ever held that Reata applies only to compensatory damages. We hold neither today. Instead, we hold that the Reata rule-under which the state, by participating in certain litigation, steps outside the sphere of protection that common-law immunity from suit provides- never applies when the state initiates litigation to enforce a substantive prohibition against unlawful conduct by imposing a monetary penalty. Sovereign immunity protects the state from counterclaims that seek to offset a penalty. Several strands in our jurisprudence support this rule.
First, "offsets" are never "germane to, connected with, and properly defensive to" whether a monetary penalty is due.
See
Reata
, 197 S.W.3d at 377. Penalties are inherently one-sided. Citizens cannot claim a penalty against the state, but the state can and does frequently assess fines, penalties, and sanctions against its citizens. Accordingly, a citizen seeking to offset a penalty must assert some other, non-penal source of the state's liability-a tort, a contract, etc. But in that situation, "one claim has no connection with the other, and the two claims are entirely independent of each other."
See
Humble Oil
,
In their conspiracy and breach-of-contract counterclaims, the Providers contend, essentially, that they should not be liable for their fraud because the state let them get away with it. This argument has nothing to do with whether the Providers violated the Act. They may have strong arguments that they did not, though we express no opinion on that point. Even under
Albert
's description of
Reata
's connectedness prong-that a counterclaim is "germane" if it is "relevant to" or "would at least inferentially rebut" the state's claim-the Providers' counterclaims have not connection with whether they violated the Act.
See
Albert
,
Similarly, the Providers' conversion counterclaim cannot meet Reata 's requirements. The Providers argue that the state has converted funds by holding money that is earmarked for services "for which [the Providers] should be paid." The problem with this argument is that whether the Providers "should be paid" is already one of the central issues in this case. That is, the conversion counterclaim is unavailable under Reata because it could never meet Reata 's other predicate-offset. See 197 S.W.3d at 378. A merits victory for the state would vindicate the state's current payment hold. The held payments would stay with the state, so they could not function as an offset for the Providers. By contrast, a merits victory for the Providers would earn them the held payments. But a win for the Providers would mean that the Providers owe no penalties and so have no judgment to offset. Nor can Reata answer whether the Providers presently deserve to possess the funds while this litigation unfolds. Offset is a requirement under Reata , see id. , and there will be nothing for the held funds to offset until this litigation concludes in the state's favor (if it does so conclude), at which point the temporary payment hold will no longer be relevant. The state's victory would eliminate the Reata hurdle, but it would also conclusively destroy the conversion counterclaim's basis. So regardless of whether the Providers seek a permanent determination that they "should be paid" or a temporary determination that they "should possess the payments" while this suit is ongoing, Reata does not help them.
Second, safeguarding the treasury is one of sovereign immunity's primary justifications in the modern era.
See, e.g.
,
Tex. Dep't of Transp. v. Sefzik
,
Many state programs and offices-including Medicaid, police departments, environmental agencies, etc.-depend at least in part for their continued existence on collecting revenue in the form of penalties. Hampering these entities' collections by abrogating their sovereign immunity injures the public fisc just as surely as allowing private citizens to sue them directly for damages. For example, under the Providers' view of
Reata
, any driver could assert a "selective enforcement" counterclaim to any speeding ticket. The driver could argue, as the Providers do here, that he thought his conduct was permissible because it went unpunished for several years. The driver might even argue that the police department and, for example, a toll-road operator, conspired to trick the driver into speeding as part of a scheme to boost tolls. Of course, such arguments would not be relevant to whether the offensive conduct actually occurred. But they would, if sovereign immunity did not protect governmental entities from their assertion, dramatically reduce entities' ability to collect revenue. That is why, in an analogous case, we recognized "the rule that taxes due [to] the State cannot be offset by an indebtedness due by the State to the tax debtor."
Humble Oil
,
Third, sovereignty itself remains an important justification for sovereign immunity.
See
Hosner v. DeYoung
,
A penalty cannot be offset against the state any more than a prison sentence. Because applying the Reata rule to penalties would run counter to Reata itself and would thwart the primary justifications underlying sovereign immunity's very existence, we conclude that the rule never applies to offset a penalty.
C
The Providers argue that even if
Reata
does not apply to penalties-or even if it applies only to damages-it applies in this case because the state is seeking damages, at least in part. The state responds that this proceeding is a "law-enforcement action" in which the state is seeking statutory "sanctions" or "penalties," or perhaps "liquidated damages" (as opposed to compensatory damages). Although some of the Act's penalties must be calculated with reference to the underlying fraud's monetary amount,
see
Xerox
,
Our decision in
In re Xerox
, also announced today, conclusively rebuts the Providers' argument.
See
Section 36.052 is penal for purposes of chapter 33 because the Act "employs a penalty scheme."
See
Reata
's abrogation-of-immunity rule does not apply when the state seeks to impose a monetary penalty to enforce a substantive prohibition against unlawful conduct. Since the state's action is punitive rather than compensatory,
see
III
Third-Party Claims
Finally, the Providers also complain that the trial court erred by dismissing their third-party claims against Xerox. The court of appeals refused to address this complaint, concluding that it lacked jurisdiction to consider the issue on interlocutory appeal.
See
Texas statutes do not authorize an interlocutory appeal from an order granting a governmental unit's motion to dismiss third-party claims on non-jurisdictional grounds. We do not address the merits of the Providers' third-party claims or whether those claims are permissible in this action. We simply agree with the court of appeals that we lack interlocutory jurisdiction to address those issues.
* * *
In 1847, this Court decided a trio of cases recognizing the fundamental principle that "[c]oercion ... is incompatible with sovereignty."
Borden
, 2 Tex. at 611 ;
see also
Hosner
,
Justice Lehrmann filed an opinion concurring in part and dissenting in part, in which Justice Johnson joined.
Justice Boyd and Justice Blacklock did not participate in the decision.
When a state appears as a party to a suit, she voluntarily casts off the robes of her sovereignty, and stands before the bar of a court of her own creation in the same attitude as an individual litigant; and her rights are determined and fixed by the same principles of law and equity, and a judgment for or against her must be given the same effect as would have been given it had it been rendered in a case between private individuals. 1
Over a decade ago, we considered "whether sovereign immunity continues to exist when an affirmative claim for relief is filed by a governmental entity."
Reata Constr. Corp. v. City of Dallas
,
In this case, the State filed suit under the Texas Medicaid Fraud Prevention Act (Medicaid Fraud Act or Act), alleging that the defendants, several dental providers offering services through the Texas Medicaid program, fraudulently obtained Medicaid reimbursements. In filing suit, the State sought to recover any payments unlawfully provided under the Medicaid program; prejudgment interest; two times the amount of any payment provided under the Medicaid program; civil penalties; and expenses, costs, and attorney's fees, as provided by the Act's "civil remedies" provision. See TEX. HUM. RES. CODE § 36.052(a). The Providers counterclaimed for breach of contract, conversion, and fraud. The issue before the Court is whether sovereign immunity bars the Providers' counterclaims. Because the State seeks "monetary relief" under Reata , I would hold that the State's decision to file this action "encompassed a decision to leave its sphere of immunity from suit." Reata , 197 S.W.3d at 377. Because the Court holds otherwise, I must respectfully express my dissent. 2
I. Background
In 1993, the mothers of children in low-income families sued the Texas Department of Health and the Texas Health and Human Services Commission under
The State ultimately agreed to settle the dispute by entering into a consent decree, which required the State, among other things, "to conduct outreach efforts aimed at increasing participation and the receipt of needed services" for Medicaid-eligible children. 5 After years of litigation, in 2007 the State began allocating millions of dollars in state and federal funding to provide these increased services, including Medicaid dental services. 6
However well-intended, these efforts attracted the scrutiny of Texas news media, and a Dallas news station reported a series of stories highlighting the State's high expenditures for dental and orthodontic services. 7 The Health and Human Services Commission, through its Office of Inspector General, subsequently attributed the high expenditures to dental fraud. The Commission imposed payment holds against various dental providers, including some of the Providers in this case. 8 Following administrative hearings, 9 the SOAH administrative law judges found that the State had failed to present prima facie evidence to support its fraud allegations and ruled that the payment holds should be reversed. 10 But the Commission refused to release the funds, in one case "alter[ing] the ALJs' findings of fact and conclusions of law and issu[ing] a final order sustaining the HHSC-OIG's payment hold." 11
The Providers filed suit, challenging the Commissioner's authority to continue holding the funds. 12 The trial courts agreed with the Providers, in one case reversing the final order sustaining the payment hold and, in another, issuing a writ of mandamus commanding the State to pay the improperly held funds. 13 The courts of appeals affirmed the trial courts' judgments in the payment-hold proceedings, ordering the State to release the held funds. 14 The State nonsuited the administrative cases and did not release the withheld funds to the Providers.
The State filed the instant suit under the Medicaid Fraud Act, pursuing the same allegations at issue in the nonsuited administrative cases. 15 The Providers responded with counterclaims for "proportional recovery of actual and exemplary damages, interest, court costs, and attorney fees against the State" for conspiracy and breach of contract, in addition to a demand that the State release the monies held as ordered by the administrative law judges, trial courts, and courts of appeals in the nonsuited administrative proceedings. The State invoked sovereign immunity in a plea to the jurisdiction.
The trial court granted the State's plea without stating its reasons. The court of appeals affirmed, holding that the
Reata
rule did not apply because (1) "the civil penalties that the State is seeking against the Dental Groups do not qualify as damages or monetary relief as those terms were used in
Reata
," and (2) "when the State pursues an enforcement action under the [Medicaid Fraud Act], it is not acting as an ordinary or private litigant as described in
Reata
but is instead acting in its sovereign capacity and exercising its police powers."
II. Analysis
The Providers contend that this case fits perfectly within our
Reata
holding: because the State asserted affirmative claims for monetary relief against the Providers, it does not have immunity against the Providers' offsetting counterclaims, which are connected, germane, and properly defensive to the State's claims. The State disagrees, arguing that in this Medicaid fraud (or any other) enforcement action, (1) the State does not seek the type of "monetary relief" we addressed in
Reata
, (2) the State does not appear as an "ordinary litigant," and (3) the defendants' counterclaims are not and cannot be connected, germane, and properly defensive to the State's claims. The Court sides with the State, holding that "the
Reata
rule ...
never
applies when the state initiates litigation to enforce a substantive prohibition against unlawful conduct by imposing a monetary penalty."
Ante
at 507. And, relying on our decision today in
In re Xerox
,
A. Judicial Abrogation of Immunity
In analyzing the reach of sovereign immunity, we must engage in a careful weighing analysis and consider the policy issues at hand.
See, e.g.
,
Olivares
,
B. Reata 's Scope
In Reata , the City of Dallas intervened in a pending tort action and asserted claims that the city's contractor and its subcontractor negligently caused the city damages when the subcontractor accidentally drilled through a water main. 197 S.W.3d at 373. The State distinguishes Reata , noting that, in this case, the State is not seeking compensatory damages under a conventional tort theory. Instead, the State contends, although this is a civil case, it is a "law-enforcement action" seeking statutory "sanctions" or "penalties," or perhaps "liquidated damages" (as opposed to compensatory damages), which are not based or calculated on the amount of damages or losses the State suffered as a result of the Providers' fraud.
The court of appeals agreed, concluding that the State sued for a "civil penalty" to "punish" the Providers for violating a public-welfare statute and to deter others from doing the same.
The Providers argue that the court of appeals erred in that conclusion because, other than its claim for an injunction, all of the State's claims in this suit are for "monetary relief." Specifically, the Medicaid Fraud Act authorizes, and the State requests in its pleadings, a monetary award including (1) the "amount of any payment" the State made "as a result of" each "unlawful act"; (2) prejudgment interest on that amount; (3) a "civil penalty" for each unlawful act; and (4) two times "the amount of any payment" made as a result of an unlawful act. See TEX. HUM. RES. CODE § 36.052(a). The Providers argue that, although Reata happened to involve tort claims for compensatory damages, our holding was not limited to those types of claims seeking that type of monetary relief. The court of appeals thus created a "distinction that Reata neither contemplates nor supports."
I agree with the Providers. The Court superficially states that " Reata uses the word 'damages' more than a dozen times," concluding that "[t]his usage indicates that we decided the case based on the narrow theory of damages rather than the broad theory of a transfer of funds." Ante at 505. Admittedly, a word search for the term "damages" reveals that we used the word thirteen times throughout the opinion, but the majority of the references are not relevant to the issue before us. 16 As relevant to the Court's analysis, we referred to the City's claim for "damages" four times in Reata , noting that the City had sued for damages and reasoning that the City's decision "to file suit for damages encompassed a decision to leave its sphere of immunity from suit for claims against it which are germane to, connected with and properly defensive to claims the City asserts"; that sovereign immunity did not apply to the subcontractor's counterclaims "made against the City which were connected to, germane to, and properly defensive to the matters on which the City based its claim for damages"; and that "the City's assertion of claims for damages against Reata means that the City does not have immunity from Reata's claims to the limited extent we have explained." 197 S.W.3d at 377. We referred once to "monetary damages," reasoning that, "if the governmental entity interjects itself into or chooses to engage in litigation to assert affirmative claims for monetary damages, the entity will presumably have made a decision to expend resources to pay litigation costs." Id. at 375.
But our discussion and our holding in Reata utilized much broader terms. Addressing not just the City's claims but the principles underlying our holding, we referred twice to claims for "monetary relief." First, we reasoned that "where the governmental entity has joined into the litigation process by asserting its own affirmative claims for monetary relief, we see no ill befalling the governmental entity or hampering of its governmental functions by allowing adverse parties to assert, as an offset, claims germane to, connected with, and properly defensive to those asserted by the governmental entity." Id. at 376-77. Second, we held that because "the City asserted affirmative claims for monetary relief against Reata, the City does not have immunity from Reata's claims germane to, connected to, and properly defensive to claims asserted by the City, to the extent any recovery on those claims will offset any recovery by the City from Reata." Id. at 378. We referred once to "monetary recovery," explaining that, once the government "asserts affirmative claims for monetary recovery, the City must participate in the litigation process as an ordinary litigant." Id. at 377. And, most broadly, we referred three times simply to the government's "recovery." We reasoned that our holding would not disrupt the government's fiscal planning if "the opposing party's claims can operate only as an offset to reduce the government's recovery." Id. at 375. We further held that immunity would still preclude jurisdiction over any counterclaim "for damages against the City in excess of damages sufficient to offset the City's recovery." Id. at 377. Finally, we concluded that the City did not have immunity "to the extent any recovery on [the counterclaims] will offset any recovery by the City from Reata." Id. at 378.
We have since characterized
Reata
's holding by using the broader terms, explaining that governmental entities "do not have immunity from offsetting claims germane to, connected to, and properly defensive to
monetary claims
by the entities."
Albert
,
Accordingly, I agree with the Providers that the language we used in Reata did not limit our analysis or our holding to government claims for "compensatory damages," but instead rested more broadly on the government's claims seeking a "monetary recovery." However, as the Court observes, Reata involved only claims for compensatory damages, and neither Reata nor any of our subsequent cases specifically address the distinction between the broader and narrower terms. In other words, this is an issue of first impression, and it may just be, as the State and the Court suggest, that we used the broader terms merely as convenient references to the compensatory-damage relief the government was seeking in those cases, rather than to limit the State's immunity when it seeks any form of monetary recovery. I would reject that suggestion, however, primarily for two reasons.
First, although
Reata
involved only claims for compensatory damages, the cases on which we relied to support our holding in
Reata
did not.
Anderson, Clayton & Co. v. State
, the case that provided the foundation for our
Reata
holding, was an enforcement action in which the State sought "recovery of penalties" against a trucking company operating without a license.
having invoked the jurisdiction of the district court ... for a judicial determination of the question as to whether the defendants were subject to the provisions of the foregoing act and liable for the penalties described therein, it became subject to the same rules as other litigants, except in so far as such rules may be modified in favor of the state by statute or may be inapplicable or unenforceable because of exemptions inherent in sovereignty .... That court at the instance of the state acquired jurisdiction of the parties and subject-matter in controversy, and, the defendants having sought affirmative relief in a cross-bill, the jurisdiction of the court cannot afterwards be defeated by the state upon a plea that the cross-petitioners were seeking an injunction against the enforcement of a penal statute.
The authorities sustain the exception to the foregoing rule that the state's immunity from suit does not extend to a suit against state officers to enjoin the enforcement of an invalid law to the injury of the legal rights of a citizen.
But the authorities sustain the further rule that, where a state voluntarily files a suit and submits its rights for judicial determination, it will be bound thereby, and the defense will be entitled to plead and prove all matters properly defensive. This includes the right to make any defense by answer or cross-complaint germane to the matter in controversy.
Anderson, Clayton & Co.
,
In
Reata
, we also relied on our decision in
Humble Oil
, which involved the State's action to recover unpaid production taxes "plus interest and
penalties.
"
Consistent with my reading of
Reata
's scope, several courts of appeals have applied
Reata
in cases involving government claims for monetary relief other than compensatory damages, including penalties, yet the Court neither cites, discusses, nor overrules those cases. For example, in
Bandera County v. Hollingsworth
, the San Antonio Court of Appeals held the County was not immune from a counterclaim for
breach of a Rule 11 agreement where the underlying suit involved the State's claim for "taxes due, together with interest, penalties, costs, expenses, and attorney's fees."
In addition to the absence of language in
Reata
and its predecessors indicating that the type of monetary recovery sought informs the offset analysis, the policies underlying the sovereign-immunity doctrine do not support the limitation the Court adopts. Consistent with our holdings in
Anderson, Clayton
and other earlier cases, we explained in
Reata
that our "determination that a governmental entity's immunity from suit does not extend to a situation where the entity has filed suit is consistent with the policy issues involved with immunity." 197 S.W.3d at 375. And "the primary concern in
Reata
was ensuring that any outcome in favor of a counterclaiming defendant would not be paid with taxpayer dollars."
Borunda
,
Accordingly, the policy reasons behind our decision in Reata support the broad language we used in that case, as well as the conclusion that Reata 's holding applies when the government chooses to file a claim for "monetary relief" or "monetary recovery," not just for "damages" or "compensatory damages," as the State suggests. And here, the State is undeniably seeking monetary relief. In this circumstance, as in Reata , "the governmental entity has joined into the litigation process by asserting its own affirmative claims for monetary relief." Id. at 376-77. I therefore "see no ill befalling the governmental entity or hampering of its governmental functions" in this case by allowing the Providers to assert, as an offset, claims germane to, connected with, and properly defensive to those asserted by the State. Id.
Moreover, it is fundamentally unfair to allow the State to assert affirmative claims against the Providers-claims that could result in millions of dollars of recovery-but deny the Providers an opportunity to merely offset that recovery with counterclaims seeking, at a minimum, the release of money that every court to adjudicate the merits of the case has held to be unlawfully retained by the government.
See
Borunda
,
C. The Court's "Law-Enforcement" Exception
The Court ignores the policy and jurisprudential concerns discussed herein, concluding instead that "sovereignty itself remains an important justification for sovereign immunity."
Ante
at 508. But as we have already explained, protecting the public fisc and public reliance on government services, not fealty to an all-powerful sovereign, underlie our modern justifications for maintaining the doctrine.
Olivares
,
The Court's law-enforcement rationale is unfounded. First, the State highlights that, when it acts in a law-enforcement capacity, it necessarily is not acting as an "ordinary litigant" as
Reata
requires. But the State's argument mischaracterizes our description of the government as an "ordinary litigant" in
Reata
. We used the term in explaining that once the government "asserts affirmative claims for monetary recovery, [it] must participate in the litigation process as an ordinary litigant, save for the limitation that [it] continues to have immunity from affirmative damage claims against it for monetary relief exceeding amounts necessary to offset [its] claims."
Reata
, 197 S.W.3d at 377. We did not hold that the
Reata
rule applies
only if
the government is participating in litigation as an "ordinary litigant"; rather, we held that
when
the
Reata
rule applies the government must
participate as
an "ordinary litigant."
Id.
This is consistent with the well-recognized principle that our procedural and evidentiary rules apply to the State as they would to any other litigant when it appears in court.
See
State v. Naylor
,
Second, a law-enforcement exception would swallow the
Reata
rule. The Court gives little guidance on how to determine whether the State is acting in a "law-enforcement" capacity as opposed to an "ordinary litigant," other than to state that the exception applies "when the state seeks to impose a monetary penalty to enforce a substantive prohibition against unlawful conduct" and that "action is punitive rather than compensatory."
Ante
at 510. But the Court's new rule obfuscates over a century of our sovereign immunity jurisprudence. As previously noted, our precedent before and after
Reata
unequivocally involved "substantive" claims, both statutory and under the common law, and many involved the imposition of "penalties."
See, e.g.
,
Anderson, Clayton & Co.
,
When any governmental body brings suit, it necessarily acts under its sovereign authority to police and enforce the laws of the State. See Reata , 197 S.W.3d at 384 (Brister, J., concurring) ("[W]hen governments bring suit, they must do so through agents who ultimately derive their authority from the Legislature .... But when they file suit on an affirmative claim, they must be doing so with legislative authorization. If the rule were otherwise, it is not clear how a government could ever assert its own claims."). The Court's decision today throws what has been a well-settled doctrine into limbo because almost any action brought by a governmental body arguably constitutes a "law-enforcement" action. 19
I see no principled basis for adopting the State's position that the Medicaid Fraud Act enables it to bring a specialized law-enforcement action that justifies an exception to the
Reata
rule. By participating in the federal Medicaid program and enacting the Act and its enabling regulations, the Legislature has already established a balanced statutory scheme for protecting the public against fraud. Under federal law, a state must have a "Medicaid fraud control unit," 42 U.S.C. § 1396a(a)(42)(B)(ii)(IV)(cc), which investigates program violations and can refer matters for criminal prosecution or "to an appropriate State agency" for other action,
D. Connected, Germane, and Defensive Nature of Counterclaims
Finally, the Court concludes that Reata does not apply to the Providers' counterclaims because they are not connected, germane, and properly defensive to the State's Medicaid fraud claims. Considering the underlying allegations, the appropriate legal standard, and the State's burden on the merits, I cannot agree with this conclusion.
Where, as here, a plea to the jurisdiction challenges the pleadings, we determine if the pleader has alleged facts that affirmatively demonstrate the court's jurisdiction to hear the cause.
City of El Paso v. Heinrich
,
We explained in
Albert
that counterclaims are "germane"-that is, "relevant"-to the government's claims when they are based on the same question as the government's claim, and are "properly defensive" when they "would at least inferentially rebut" the government's allegations.
Unlike the Court, I conclude that the counterclaims are relevant and defensive to the State's claims. On the merits, the State must show that the Providers acted "knowingly" in undertaking the unlawful acts defined in the statute.
See
TEX. HUM. RES. CODE § 36.002. The Providers allege that the State and Xerox conspired to mislead the Providers into believing that their requests complied with the Program's requirements. As the Providers frame their complaint, "the State now seeks to recoup the payments that it made to the [Providers] after the [Providers] provided the very services the State had deemed to be medically necessary." (Footnote omitted). Thus, contrary to the Court's conclusion, the Providers' allegations, if true, negate the State's assertion that they knew the services submitted for reimbursement were not medically necessary, which is a material element of each of the State's claims. These allegations are clearly connected and relevant to the parties' claims, and if the Providers are correct, their counterclaims will rebut the allegations on which the State's claims are based.
See
State v. Martin
,
III. Conclusion
When we explained the limited scope of the government's immunity against counterclaims in Reata , we relied on the policies that justify the doctrine in the first instance. Because the Reata rule permits only germane and properly defensive counterclaims and permits relief only in the form of an offset against the government's monetary recovery, we concluded that it "would be fundamentally unfair to allow a governmental entity to assert affirmative claims against a party while claiming it had immunity as to the party's claims against it." 197 S.W.3d at 375-76. For the reasons explained, I reach the same conclusion here and would hold that the State is not entitled to dismissal of the Providers' counterclaims. Because the Court holds otherwise, I must respectfully express my dissent.
State v. Cloudt
,
For the reasons the Court explains, I agree that we lack interlocutory jurisdiction to address the dismissal of the Providers' third-party claims.
Frew ex rel. Frew v. Hawkins
,
Frew v. Gilbert
,
Id. at 588-89.
See
Act of May 25, 2007, 80th Leg., R.S., ch. 1429, § 19,
See, e.g. , Byron Harris, Crooked Teeth: Medicaid Millions , WFAA (Jan. 9, 2012 1:10 PM CST), http://www.wfaa.com/news/local/investigates/crooked-teeth-medicaid-millions_20161017055833341/336726628.
See
Tex. Health & Human Servs. Comm'n v. Antoine Dental Ctr.
,
A provider subject to a payment hold, which the Commission may impose without prior notice on a provider's Medicaid reimbursements upon a credible allegation of provider fraud, may request an expedited administrative hearing before the State Office of Administrative Hearings.
Shamrock Psychiatric Clinic, P.A. v. Tex. Dep't of Health & Human Servs.
,
Antoine Dental Ctr.
,
Antoine Dental Ctr.
,
Harlingen Family Dentistry
,
Harlingen Family Dentistry
,
The State also filed a separate suit against Xerox Corporation, the private contractor charged with administering the Texas Medicaid program and assessing the medical necessity of providers' reimbursement claims, for violations of the Medicaid Fraud Act. See State v. Xerox Corp. , No. D-1-GV-14-000581 (53rd Dist. Ct., Travis County, Tex. May 9, 2014).
For example, two of the references appear in a discussion of the United States Supreme Court's sovereign immunity jurisprudence.
Reata
, 197 S.W.3d at 375 ("The United States Supreme Court has also recognized that suits for money damages against states 'may threaten the financial integrity of the States' and that 'at the time of the founding, many of the States could have been forced into insolvency but for their immunity from private suits for money damages.' " (quoting
Alden v. Maine
,
See also
City of Dallas v. Martin
,
The Court's reference to "spurious counterclaims" is curious, as it implies a connection between a claim's merits and the government's immunity. Whether the government is immune from suit has nothing to do with the strength or weakness of the claims asserted against it.
See, e.g. , Tex. Ag. Code §§ 17.152, .153 (providing for civil action for actual damages, treble damages, and civil penalties, or action under the DTPA for failing to post notice of fuel tax rates, or document or record those rates); Tex. Bus. & Com. Code §§ 15.21 (providing that any "person or governmental entity" who is harmed by unfair trade practices under the Antitrust Act "shall recover" actual damages, interest, and treble damages), 17.953 (providing for the State's recovery of restitution and civil penalties for violations of the Deceptive Trade Practices Act); Tex. Ins. Code § 541.151 (providing for civil penalties for unfair competition and deceptive acts in insurance industry); Tex. Occ. Code §§ 351.603, .604 (providing for civil penalties for violations of the Optometrists Act).
See Tex. Pen. Code § 35A.02(a)(1)-(12) ; see also Tex. Hum. Res. Code § 32.0391 (establishing a criminal offense for kickback and bribery schemes).
See Tex. Hum. Res. Code §§ 32.039 (outlining "Damages and Penalties" the State may seek in an administrative action against a provider accused of Medicaid fraud), 36.006 ("The application of a civil remedy under this chapter does not preclude the application of another common law, statutory, or regulatory remedy, except that a person may not be liable for a civil remedy under this chapter and civil damages or a penalty under Section 32.039 if the civil remedy and civil damages or penalty are assessed for the same act.").
See
Reference
- Full Case Name
- Dr. Behzad NAZARI, D.D.S., Et Al., Petitioners, v. the STATE of Texas; Xerox Corporation; And Xerox State Healthcare, LLC F/K/A ACS State Healthcare, LLC, Respondents
- Cited By
- 62 cases
- Status
- Published