N O T FO R PUB L ICAT IO N
UNITED STATES C OUR T OF APPEALS
FOR THE NINTH C IR C UIT

ANI GHAR IB IAN, R e la tor; e x re l Unite d Sta te s of Am e ric a ,

Pla i ntiff-Appe lla

nt,

a nd
UNITED STATES OF AM ER IC A; e t a l.,

Pla i ntiffs,

v. VALLEY C AM PUS PHAR M AC Y, INC ., DB A TNH Adva

nc e d Spe c ia l ity Pha rm a c y ; e t

a l ., De fe nda n ts-Appe lle e s. No. 21-56253
D.C . No. 2:16-c v-04777-M C S-PLA

M EM O R ANDUM *

Appe a l from

the Unite d

Sta t e s Distric t C ourt for the C e ntra l Distric t of C a lifornia M a rk C

. Sc a rsi, Distric t Judge , Pre siding Argue d a nd Subm i tte d Nove m

be r 17, 2022 Pa sa de n a , C a l ifornia 

# F IL ED

JAN 17 2023
M OLLY C. DW Y ER, CLERK U

. S. CO URT O F APPEALS

* This disposition is n o t ap p r o p r ia te for public a tion a nd is not pre c e de nt e xc e pt a s provide d

by Ninth C irc uit R

ule 36-3.B e fore : TASHIM A a nd NGUYEN, C irc uit Judge s , an d F ITZW ATER , ** Distric t

Judge

. Appe lla

nt Ani Gha

ribia n (“ Gha ribi an” ) a p pe a ls t he dism issa l unde r Fe de ra l
R ule of C ivil Proc e dure 12(b)(6) of he r qui tam a c tion a lle ging F al se C la im s A c t viola tions a nd re la te d sta

te -la w c la i m s. W e ha ve jurisdic t ion unde r 28 U.S.C

. § 1291,

a nd we a ffirm

. G ha ribia n, a s a qui tam re la tor, sue d De fe nda n ts-Appe lle e s Va lle y C am pu s Pha rm a c y , Inc ., d/b/a TN H A dva nc e d Spe c ia l ty Pha rm a c y (“ TNH” ), Diplom a t Pha rm a c y , Inc

. , a nd Opum R x, Inc

. (c olle c tive ly , “ Appe l le e s” ), a lle g ing tha t the y h a d

e nga ge d i n a fra u dule nt c o urse of c onduc t tha t viola te d the fe de ra l Fa lse C la im s Ac t, 31 U.S.C

. §§ 3729-3733 (“ FC A” ), a nd v a rious a na l o go u s s t at e la ws. In sum , Gha ribia n, a f o rm e r TNH e m

ploy e e , a lle g e d tha t Appe lle e s ha d i nstruc te d the ir

e m ploy e e s to m isre pre s e nt who the i r e m ploy e rs we re a nd to fa lsify pa tie nt re c ords in orde r t o proc ure prior a

uthoriz a tions for pre sc ription m e dic a tions from insura nc e provide rs. Afte r dism issing Gha ribia n’ s c om pla int a nd gra

n ting he r le a ve to a

m e nd, the distric t c o urt dism is se d Gha ribia n’ s se c ond a m e nde d c om pla int (“ SAC ” ) for fa ilure to sta

t e a c l a im . Gha

ribia n a p pe a ls the judgm e nt dism i ssing he r SAC

.

* * The Honora

ble Sidne y A. Fitz wa te r, Unite d Sta te s D istric t Judge for the Northe rn Distric t of Te xa s, sitting by de signa tion.
2The distric t c ourt dism isse d Gha ribia n’ s c l a im s re l a te d to Appe l le e s’ i nstruc ting the i r e m ploy e e s to m isre pre se nt who the ir e m ploy e rs we re o n th e g rounds tha t the
SAC did not a de q

ua t e ly ple a d m a te ria lity a nd t ha t m ost o f t he a lle g e d

m isre pre se nta tions did not involve c la im s m a de to gove rnm e nt pa y ors. Th e d i s t r i ct

c ourt dism isse d

the a lle ga t ions pe rta i ning to fa lsify ing pa tie n t re c ords o n the ground tha t the y la c ke d spe c i fic ity

. W e re vie w de novo the gra nt of a m otion t o dism iss for fa ilure to s ta te a c la im

. E.g. , Le e v
. C

ity of Los Ange le

s , 250 F.3d 668, 679 (9th C ir. 2001). W e pre sum e tha t

a ll fa c t ua l a lle ga tions in the ope ra tive c o m p l ai n t a re true , a nd we vie w t he m in the light m ost fa vora

ble to the a

ppe lla nt, but we disre ga

rd c onc lusory a lle ga tions. Id

. “ In

re vie wing the d i s m i s s al of a c om pla int, we inquire whe the r the c om pla int’ s fa c tua l

a lle ga tions, toge the r with a ll re a sona ble infe re nc e s, sta

te a pla usible c la im for re lie f.”
Unite d State

s e x re l. C afasso v
. Ge n. Dy nam i cs C4 Sy s., Inc

. , 637 F.3d 1047, 1054 (9th C ir. 2011). “ W e c a n a ffirm a 1 2(b)(6) d ism issa l on a ny g round supporte d by the

re c o rd, e ve n if the d i s t r i ct court did not re ly on the ground.” Unite d S tate s v
. C orinthian C

olls. , 655 F.3d 984, 992 (9th C ir. 2011) (inte rna l q uota tion m a rks

om i tte d).

“ [A] pla intiff m

ust ple a d FC A c la im s with pa rtic ula rity unde r Fe de ra l R

ule of
C ivil Proc e dure 9(b).” W inte r e x re l. Unite d State

s v
. Garde ns Re

g’l Hosp. & Me d.

3C

tr, Inc

. , 953 F.3d 1108, 1116 (9th C ir. 2020) (inte rna l quota tion m a rks om itte d). “ In

a lle ging fra ud or m ista

ke , R u le 9(b) re quire s a par t y to sta te with p a rtic ula

rity the

c irc um s ta nc e s c onstituting fra u d or m i sta k e , i n cl u d i n g the who, w ha t, whe n, whe re ,

a nd how of the m i s co n d u ct ch a rge d.” Ebe id e x re l. Unite d S

tate s v
. Lungw itz , 616 F.3d 993, 998 (9th C ir. 2010) (inte rna l quota tion m a rks a

nd a lte ra tion om itte d).
In the c onte xt of the FC A, “ it is suffic ie nt to a lle ge pa rtic ula r de ta ils of a

sc he m e to subm it fa lse c la im s pa ire d with re lia b le indic ia th at l ea d to a strong infe re n c e tha t c l a im s we re a c t ua lly subm itte d.” Id

. a t 998-99 (inte rna l quota tion

m ar k s o m i t t e d). “ R

ule 9(b) doe s not re quire a re la tor to a lle g e the de ta ils of e ve ry fa lse c la im subm itte d t o the fe d e ra l gove rnm e nt for re im burse m e nt.” U

n it ed State

s

e x re l. Solis v . Mille nnium Pharms., Inc

. , 885 F.3d 623, 628-29 (9th C ir. 2 018). B ut

a lle ga tions m a de on the ba sis of “ inform a tion a nd be lie f,” suc h a s t hose in the insta

nt SAC , m ust a lso sta

te the fa c tua l ba sis for t he be l ie f. N e ubronne r v
. Milk

e n , 6 F.3d 666, 672 (9th C ir. 1993). The FC A is “ inte nde d to re a c h a ll t y p e s of f r aud, without qua lific a t ion, tha t

m ight re sult in fina

nc ia l loss to t

he G ov e rnme n t .” Unite d State s v
. N e ife rt-W hite C o
. , 390 U.S. 228, 232 (1968) (e m pha sis a dde d). The e le m e nts of a n FC A c la im a re “ (1)

a fa lse sta te m e nt or fra udule nt c ourse of c onduc t, (2) m a de with sc ie nte r, (3) tha t wa s

m a te ria l , c a

using (4) the gov e rnme nt to pa y out m one y or forfe it m o ne y s due .” Unite d

4State

s e x re l. He ndow v
. Univ

. of Phoe nix , 461 F.3d 116 6 , 1 174 (9th C ir. 2006) (e m pha sis a dde d). Ac c ordingly , to ple a d a p la usible FC A c la im a nd a c la i m unde r
sta te -la w a na logue s, a c om

pla int m ust a de qua t el y al l eg e tha t the c l a im wa s m a de to

a gove rnm e nt pa

y or. 1. W ith re spe c t t o a ll but two a lle ga tions, the SAC do es not a de qua te ly ple a d tha t a fa l se c l a im wa s m a de to a gove rnm e n t p a y or. The ina de qua te pa rts of the SAC

a re insuffic ie nt e ithe r be c a use the y spe c ific a lly ide ntify a p r i va t e insure r— for insta nc e , “ ‘ Anthony ’ c a lle d Expre ss Sc ripts for Anthe m ,” or “ [i] n a n August 1, 2016 phone c a ll to B lue Cr o ss Blue Shie l d of M ic higa n”

— or be c a

use the y a re

c onc lusory

— for e xa m

ple , a sse rting t

ha t Appe lle e s “ re gula

rly m ad e f

a lse a n d fra udule nt s ta t em en t s t o gove rnm e nt a nd priva te insure rs.” The form e r c a te gory of

a lle ga tions fa ils to ple a d a gove rnm e nt p ayo r
. The la tte r c a te gory is ba se d o n

“ inform a tion a nd be lie f” a nd d oe s not a de qua te ly s ta te the fa c tua l ba sis for the be lie f.
For the se re a sons, a ll but two a lle ga tions of the SAC fa il to ple a d a pla usible c la im for

re lie f.
2. Th e r em a ining two a lle ga tions a re a lso insuffic ie nt, but for a diffe re nt

re a s on: the y fa il to a de qua te ly a lle ge m a te ria lity

. M a te ria lity, l ike the e xiste nc e of a
gove rnm e nt pa

y or, i s an esse ntia l e le m e nt of a n FC A c la i m
. He ndow , 461 F.3d a t 1174. “ Unde r the [FC A] , t he m isre pre se nta tion m

ust be m a te ria l to the othe r pa rty ’ s

5c ourse of a c tion.” U niv e rsal He alth Se rv

s., Inc

. v
. U

nite d State

s e x re l. Esc o bar , 579 U.S. 176, 191 (2016). The FC A de fine s m a te ria lity a s “ ha ving a n a tura l te nde nc y to influe n c e , or be c a

pa ble of influe nc ing, the pa

y m e n t or re c e i pt of m one y or p rope rty .”
31 U.S.C

. § 3729(b)(4). “ Unde r a ny unde rsta nding of the c onc e pt, m a te ria lity looks
to t he e ffe c t on the like ly or a c tua l be ha vior of the r e c ipie nt of the a lle g e d

m isre pre se nta tion.” Esc obar , 579 U .S. a t 1 9 3 ( i n te rna l quota tion m a rks a

n d

a lte ra tions om i tte d).
B oth re m a ining al l e ga tions p e rta in to Appe lle e s ’ pra c tic e of instruc ting the ir

e m ploy e e s to m isre pre se nt t he ide ntitie s of the ir e m plo yer s whe n se e k ing prior

a uthoriz a tions for pre sc ription m e dic a tions from insura nc e provide rs. The a lle ga tions of t he SAC do not pla

usibly p le a d tha t this pra c tic e w a s m a te rial to a n insure r’ s de c ision to gra nt prior a

u t horiz a tion. The SAC d oe s not a lle ge tha t insu r er s w o u ld ha ve re fuse d to pa

y ha d the y k

nown tha t the re que st wa s co m i n g f rom a pha

rm a c y

ra the r tha n from a phy s ic ia n’ s offic e
. Gha ribia n’ s a uthoritie s supporting the proposition tha t phy sic ia ns a re suppose d
to be the one s obta ining p rior a uthoriz a tions do n ot e s ta

blish tha t the c a lle r’ s ide ntity is inform a tion tha t would influe nc e the de c ision-m a king of insura nc e provide rs. The Supre m e C o urt ha s he ld tha t “ whe n e va lua ting m a t e ria lity unde r t he Fa lse C la im s Ac t, the Gove rnm e nt’ s de c ision to e x pre ssly ide ntify a provision a s a c ondition of pa y m e nt

6is re lev a nt, but not a utom a tic a lly dispositive .” Esc obar , 579 U .S. a t 194. Som e M e d ic a re re gula

tions a p pe a r, in fa c t, to c onte m

pla te that i ndividua l s othe r tha n phy sic ia ns or the ir re p re se nta tive s will be t he one s obta ining prior a uthoriz a tions o n be ha lf of pa

tie nts. Se e

, e .g. , 42 C .F.R . § 423.566(b).
B e c a use t h e SAC fa ils to a de qua te ly ple a d m a te ria l ity w ith re spe c t to the two

re m a ining a lle ga tions, the distric t c ourt did not c om m it re ve rsible e rror in dism issing the SAC in its e ntire ty

. AFFIRM E D

.

7