CHARLESTON — The West Virginia Supreme Court of Appeals has issued a writ of prohibition preventing a West Virginia man from pursuing claims against the Medicaid Fraud Control Unit.
In this consolidated legal proceeding, the West Virginia Attorney General’s Medicaid Fraud Control Unit and Nathan R. Lyle, an MFCU investigator, are appealing the circuit court’s denial of their motion to dismiss specific claims in a civil rights action initiated by Hisel Bailey, according to the Nov. 9 opinion of the West Virginia Supreme Court.
Justice Haley Bunn authored the majority opinion. The appeal involves two separate issues, with two separate case numbers.
"The Attorney General’s Office is pleased the West Virginia Supreme Court of Appeals has issued a writ of prohibition preventing Hisel Bailey from pursuing claims against the Medicaid Fraud Control Unit and a former MFCU investigator," West Virginia Attorney General's Office Press Secretary John Mangalonzo told The West Virginia Record. "We feel confident the remaining count will ultimately be dismissed as well."
In the first, the petitioners seek a writ of prohibition to prevent the circuit court from enforcing its order allowing Bailey to maintain U.S. code claims against both MFCU and Lyle.
The petitioners also argued to prevent the court from permitting Bailey to proceed with a whistle-blower claim against Lyle.
The court grants the writ of prohibition, asserting that MFCU, as a state agency, and Lyle in his official capacity, cannot be subjected to U.S. code claims.
Bunn also wrote that Bailey's whistle-blower claim is deemed unsustainable because Lyle lacked the authority to make decisions affecting Bailey's employment. Thus, he was not considered Bailey's employer under the whistle-blower law.
In the second case, the petitioners appeal the circuit court’s denial of qualified immunity concerning Bailey’s U.S. code claims against Lyle for unreasonable seizure of the person. These claims are based on alleged violations of Miranda v. Arizona and potential loss of liberty resulting from a false report submitted by Lyle.
The court rules in favor of the petitioners, stating that as a matter of law, a claim under the U.S. code cannot be founded on a Miranda violation. It further emphasizes that the mere risk of a loss of liberty is insufficient to establish a seizure of the person, entitling Lyle to qualified immunity.
The court also addresses the petitioners’ appeal regarding malicious prosecution claims. It concluded that Bailey's complaint failed to meet the required pleading standard to overcome the petitioners’ qualified immunity.
The court notes the absence of analysis regarding whether Lyle acted within the scope of his employment, a crucial factor in determining MFCU’s entitlement to qualified immunity for vicarious liability. Consequently, additional proceedings before the circuit court are deemed necessary.
The order is affirmed in part and reversed in part, necessitating a remand for further proceedings consistent with the court’s opinion.
The decision also confirms that the petitioners are not entitled to absolute prosecutorial immunity.
The Supreme Court's decision grants the writ of prohibition in the first case, denying the U.S. code claims against MFCU and Lyle in his official capacity. In the second case, the court reverses the denial of qualified immunity for Lyle regarding the U.S. code claims, dismisses Bailey’s malicious prosecution claim due to insufficient pleading and affirms the denial of absolute prosecutorial immunity for Petitioners.
The case is remanded for further proceedings consistent with the court's findings.
West Virginia Supreme Court of Appeals case number: 22-779, 22-781
