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Enos v. Orthopedic & Spine Physical Therapy of L/A, Inc.

Superior Court of Maine, Androscoggin

November 18, 2014

JANET ENOS, Plaintiff
v.
ORTHOPEDIC & SPINE PHYSICAL THERAPY OF L/A, INC., and SHAN TEIXEIRA, Defendants

ORDER

MaryGay Kennedy Justice.

Before the court is Defendant Shan Teixeira's Motion to Dismiss Plaintiff Janet Enos's Complaint against him pursuant to Rule 12(b)(6). Enos's Complaint is for declaratory and injunctive relief as well as monetary damages pursuant to the Maine Human Rights Act, 5 M.R.S.A. § 4551 et seq. This court held a hearing on Teixeira's Motion, and has reviewed each party's filings regarding the Motion.

I. Factual Background

The following facts are gathered from the Complaint. Defendant Orthopedic & Spine Physical Therapy of LA, Inc. ("Orthopedic & Spine") is a Maine Corporation located in Lewiston. Teixeira is the owner and sole professional provider at Orthopedic & Spine. From approximately February 2007 to April 19, 2012, Enos was employed by Orthopedic & Spine as a receptionist and office manager. Teixeira supervised Enos directly and completed all of her annual reviews and evaluations. Enos received excellent annual reviews.

In August of 2009, Enos took a continuing education course on physical therapy coding and billing. She completed the class on August 14, 2009, and on August 18, 2009 Enos brought possible billing errors, including potentially fraudulent billings, to Teixeira's attention.

Teixeira informed Enos that instituting or requiring new policies was not a part of her role, but that he would take her concerns under consideration. Enos also raised concerns to Teixeira regarding his treatment notes, the inadequacy of treatment notes to justify MaineCare and Medicare billings, and possible overbilling. Teixeira defended his notes, and when Enos stated she did not want to be a party to potentially fraudulent billings, Teixeira allegedly responded along the lines of if Enos was not actually performing the billing then she was not committing fraud.

While Enos continued to do the in-house billing, she would raise concerns with Teixeira, who responded by yelling and defending his practices, and telling Enos all she needed to do was enter and bill. Enos eventually ceased to question Teixeira.

Insurance companies would sometimes ask for additional notes and support for treatments billed by the Defendants. Teixeira sometimes asked that Enos enter additional notes into bills that insurance companies questioned, and the Defendants asked that she make changes to files or notes, but Enos refused. The Defendants also failed to change their billing practices.

Enos subsequently reported the Defendants to Medicare and MaineCare authorities. After a MaineCare audit began around late 2011 or early 2012, Teixeira repeatedly asked Enos to make changes to records, notes and time entries, which Enos once again declined to do. In 2011, Medicare also requested and reviewed files. The requests from the Defendants continued (and were denied by Enos) after MaineCare issued a recoupment payment letter based upon unclear billing and inadequate notes and the Defendants appealed the letter. The Defendants paid on MaineCare's final recoupment request.

The relationship between the Defendants and Enos worsened and Teixeira began to look for a candidate to replace Enos. She was eventually fired on April 19, 2012. Teixeira attributed Enos's firing to the fact that they were not getting along and, Enos's refusal to cooperate with some of his past requests. Enos stated that she felt Teixeira's requests were illegal and she requested a Separation letter. The separation letter did not state why Enos was fired. Enos claims the Defendants justifications for her termination were pretextual, and asserts she was fired for complaining about what she perceived to be, or what actually were, illegal activities on the part of the Defendants.

Enos filed a complaint with the Maine Human Rights Commission ("MHRC") claiming discrimination based on retaliation. On November 13, 2013, after investigating the Plaintiffs complaints, the MHRC dismissed the action and issued a right to sue letter.

II. Discussion

When considering a motion to dismiss under Rule 12(b)(6) the Law Court has held that:

'[w]e view the material allegation of the complaint as admitted and examine the complaint in the light most favorable to the plaintiff to determine whether it sets forth elements of a cause of action or alleges facts that would entitle the plaintiff to relief pursuant to some legal theory. A dismissal is appropriate only when it appears beyond doubt that a plaintiff is entitled to no relief under any set of facts ...

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