FIL ED U.S. COURT OF APPEAL S EL EVENTHCI RCUI T J UNE 9, 2011 J OHN L EY CL ERK [DO NOT PUBLISH] IN THE U

NITED STATE S COURT OF APPEALS FOR THE ELE VENTH CIRCUIT

__ __ __ __ __ __ __ __ __ __ __ __ No. 1 0- 14 75 9 Non -Arg um en t Ca le nd ar

__ __ __ __ __ __ __ __ __ __ __ __ D.C. Dock etNo. 8 :0 9- cv -0 03 05 -SDM- TGW UNITED STAT ES OF AMERIC A, ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll Pl ai nt iff , W ILLIAM SEAN MIC HAEL L OW RY, lll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll l Pl ai nt iff -Ap pe ll an t, vers us WALGREEN COMPANY, INC., lll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll ll l Defen da nt -Ap pe ll ee

__ __ __ __ __ __ __ __ __ __ __ __ App eal fro m

th e Uni te d S ta te s Di st ric t Co urt forth e Mi dd le Dis tri ctof F lo rid a

__ __ __ __ __ __ __ __ __ __ __ __ (Jun e 9 , 20 11 ) Befo re EDMONDSON, PRYOR an d B LACK, Circ ui t Jud ge s. PER CURI AM:W il li am Lowry ap pe al s the di sm is sa l o f hi s Fa ls e Cl ai m s Act qu i tam act io n ag ai ns t Walg reen Co m

pa ny, Inc. (Walg reen ) an d the de ni al of h is m ot io n fo r le av e to fil e a thi rdam en de d c om pl ai nt . On ap pe al , Lowry arg ue s the di st ric t co urt m is in te rp ret edth e te rm

“ actua l ch arg e o n the cla im forpro gr am

be ne fit s” in42 C.F.R. § 41 4.9 04 . After r ev ie w, we affi rm . 1 The Fal se Cla im s Actpro hi bi ts kn owi ng ly pres en ti ng “ a fal se or f rau du le nt cl ai m forpa y m en t o r ap pr ov al ” o r kn owi ng ly m ak in g o r us in g “ a fal se reco rdor st at em en t m at eri al to a fal se or f rau du le ntcla im .” 31 U.S.C. § 3 72 9( a)(1 )(A), (B) .

“ The Fal se Cla im s Actdo es no t cr eat e li ab il ity m erel y fora he al th care pro vi de r’s di sr eg ardof Go ve rn m en t re gu la ti on s o r im pr op er i nt ern al po li ci es un le ss , as a res ul t o f su chact s, the pro vi de r kn owi ng ly ask s the Gov ern m en t t o p ay am ou nt s i t do es no t o we.” Uni te d Sta tes ex rel . Clau se n v . Lab . Cor p. o f Am., Inc
. , 29 0 F .3d 13 01 , 13 11 (11 th Cir . 20 02 ). Med ic are wi ll rei m

bu rs e a h eal th care pro vi de r fo r 95 % of afluva cci ne ’s av erag e who le sa le pri ce. 4 2 U.S.C. § 13 95 u( o) (1 )(A)(i v) . Sect io n 1 39 5u (o )’s im pl em en ti ng reg ul at io n s ta te s tha t s uc h re im bu rs em en t i s b as edon “ th e le ss er o f

We reviewa district cour t’s dismiss al of a

complaint for f

ailure to state a

claim de 1 novo , “ac ceptingthe alleg ations in the complaint as true a nd construingthem in the light most favor able to the plaintiff.” Timson v. Sampson , 518 F.3d 870, 872 ( 11th Cir. 2008)
. We also revie ws issues of statutory interpre tation de novo . Id.

2. . . [t]he actua l ch arg e o n the cla im for pro gr am be ne fit s; or . . . 95 pe rcen t o f th e av erag e who le sa le pri ce.” 4 2 C .F.R. § 4 14 .90 4( a), (e) . The di stric t co urt d idno t err in di sm is si ng Lowry’ s ac ti on an d d en y in g h im le av e to fil e a thi rdam en de d c om pl ai nt . Se e Sib le

y v. La ndo , 43 7 F .3d10 67 , 10 73 (1 1t h C ir. 2 00 5) (st at in g adi stric t co urt m ay di sm is s wh ere a n “ am en dm en t wo ul d be fut il e”). Fi rs t, Lo wry ’s sec on d a m en de d c om pl ai ntfai le d t o s ta te a cl ai m be cau se itcit eda reg ul at io n g ov ern in g M ed ic ai d re im bu rs em en ts whi le all eg in g th atW al gr eenfil edfrau du le ntMed ic are c la im s. Sec on d, an am en dm en t wo ul d ha ve be enfut il e b ecau se Lowry’ s p ro po se d thi rdam en de d c om pl ai ntals o fa il edto st at e a cl ai m

un de r th e Fal se Cla im s Act . Se e Sib le y , 47 3 F .3dat 1 07 3. Th e p la in lang ua ge of b oth 4 2 U.S.C. § 13 95 u( o) an d 4 2 C .F.R. § 4 14 .90 4 m erel y set s an up pe r rei m

bu rs em en t l im itof 9 5% o f th e v acci ne ’s ave rag e who le sa le pri ce, an d no th in g i n e ithe r se ct io n re fere nc es a pr ov id er’s ad ve rti se d p ric e o r “us ua l an d cu st om ary ch arg e.” Acco rd in gl y , we affi rm th e d is tri ctco urt’s d is m is sa l o f th e act io n andth e d en ia l o f le av e to fil e a thi rdam en de d c om pl ai nt . AFFIRMED.

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