# U ni te d S ta te s Co ur t of A pp ea ls

For the Eig hth Circu it

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No. 1 3- 16 54

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Uni te d S ta te s o f Am eri ca an d S ta te of I owa , ex r el Su sa n Th ay er

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff s - Ap pe ll an ts

v.

Pl an ne d P aren th oo d o f th e Heart la nd

ll ll ll ll ll ll ll ll ll ll l Defe nd

an t - Ap pe ll ee

Uni te d S ta te s o f Am eri ca; Sta te of I owa

ll ll ll ll ll ll ll ll ll ll l In te re st ed

pa rt ie s

__ __ __ __ __ __

App eal fro m

Uni te d S ta te s Di st ric t Co ur t

fo r th e So ut he rn Dis tri ct of I owa - Des M oi ne s

__ __ __ __ __ __

Su bm it te d: Nov em

be r 20 , 20 13

Fil ed : Au gu st 29 , 20 14

__ __ __ __ __ __

Befo re WOL LMAN, COLLOTON , and GRUENDER, Circu it Ju dg es

.

__ __ __ __ __ __

W OLLMAN, Circ ui t J ud ge

.

Su sa n Tha y er br ou gh t th is qu i ta m act io n ag ai ns t Pl an ne d Pare nt ho o d of th e

Heart la nd

, In c. (Pl an ne d Pare nt ho od ), al le gi ng th at Pl an ne d Pare nt ho od vi ol at ed th eF a l se Cl ai m s Act (FCA), 31 U.S.C. §§ 37 29 -3 73 3, an d th e Io wa Fal se Cl ai m s Act

(IFC A), Io wa Co de Ann

. §§ 68 5.1 -.7, by su b m it ti ng fal se or frau du le nt cl ai m s fo r

Med ic ai d rei mb u rs em en t. The di st ric t co ur t di sm is se d he r co m pl ai nt fo r fai lu re to

pl ead frau d wit h th e p art ic ul ari ty requ ire d b y Fed eral Ru le of C iv il Pro ced ur e 9( b)

.

W e aff irm in pa rt, re ve rs e in pa rt, a nd rem an d fo r fu rth er p ro ceed in gs

.

I. Back gr ou nd

Pl an ne d Pare nt ho od is an Io wa no n- pr of it co rp or at io n th at pr ov id es

rep ro du ct iv e he al th care se r v i ces to pa ti en ts , i nc lu di ng Tit le XIX Med ic ai d- el ig ib le

pa ti en ts

. Fro m 19 91 to Decem be r 20 08

, Tha y er was em

pl oyed as th e cen te r m an ag er

of Pl an ne d Pare nt ho od ’s cl in ic in St or m Lak e, Io wa. Fro m 19 93 to 19 97

, Tha y er al so

se rv ed as th e cen t e r manag er of Pl an ne d Pare nt ho od ’s cl in ic in LeMar s, Io wa.

Pl an ne d Pare nt ho od op erat ed a to ta l of se ve nt een cl in ic s th ro ug ho ut Io wa du rin g th e

pe rio d o f Tha y er’s em

pl oym en t.

Tha y er’s act io n se ek s to reco ve r fu nd s th at Pl an ne d Pare nt ho od al le ge dl y

ob ta in ed in vi ol at io n of th e FCA an d th e IFCA. Tha y er’s se co nd am en de d co m pl ai nt

(h erei na fte r th e co m

pl ai nt ), al le ge s th at Pl an ne d Pare nt ho od wro ng fu l l y ob ta in ed

Med ic ai d rei m

bu rs em en ts fo r pr es cri pt io ns an d se rv ic es th at e i t h er were no t

rei m bu rs ab le or were no t rei m bu rs ab le in th e am ou nt s cl ai m ed

. Sp eci fic al ly, Tha y er

al le ge s th at Pl an ne d Pare nt ho od : (1 ) fil ed cl ai m s fo r un ne ces sa ry qu an ti ti es of bi rth

co nt ro l pi ll s th at of

te n were pr es cri be d wit ho ut ex am in at io ns or were no t rece iv ed by

Pl an ne d Pare nt ho od pa ti en ts ; (2 ) so ug ht rei m bu rs em en t fo r ab or ti on -rel at ed se rv ic es

in vi ol at io n of fed eral la w an d in st ru ct ed pa ti en ts who ex pe rie nc ed ab or ti on -rel at ed

co m pl ic at io ns to gi ve fal se in fo rm at io n to m ed ic al pr of es si on al s at ot he r ho sp it al s,

cau si ng th os e m ed ic al pr of es si on al s to un kn owi ng ly fil e c l a i ms fo r se rv ic es

pe r f o r med in co nn ect io n wit h ab or ti on s; (3 ) fil ed cl ai m s fo r th e fu ll am ou nt of

se rv ic es th at ha d a l r e a dy be en pa id

, in who le or in pa rt, by “ do na ti on s” Pl an ne d

Pare nt ho od co erce d fr om pa ti en ts ; an d (4 ) fi le d c la im s fo r m or e ex pe ns iv e se rv ic es

-2

-th an were act ua ll y pe rfo rm ed by en ga gi ng in a pr oc es s kn own as “ up co di ng .” Tha y er

al le ge s th at al l of Plan ne d Paren th oo d’s cli ni cs pa rti ci pa te d in th es e fo ur frau du le nt

sc he m es fro m earl y 20 06 to Decem be r 20 08

. The co m

pl ai nt

, ho wev er, do es no t

in cl ud e an y rep res en ta ti ve ex am pl es of th e fal se cl ai m s th at Th a ye r a l le ge s th at

Pl an ne d P aren th oo d s ub m it te d fo r rei m bu rs em en t.

Pl an ne d Pare nt ho od m ov ed to dism iss the co m pla int

, ar gui ng th at Tha y er fai le d

to al le ge frau d wit h pa rti cu la rit y as req ui red by Ru le 9( b)

. The di st ric t co ur t gr an te d

Pl an ne d Pare nt ho od ’s m ot io n, co nc lu di ng th at Tha y er fai le d to m eet th e pl ea d i ng

req ui rem en ts of Ru le 9( b) as art ic ul at ed in Uni t e d St at es ex rel

. Jo sh i v. St

. Luk e’s

Hos pi ta l, In c., 44 1 F.3 d 55 2 (8 th Ci r. 20 06 ), be cau se sh e fai le d “ to pr ov id e a si ng le

sp eci fic ex am

pl e of a pa rti cu la r frau du le nt cl ai m Pl an ne d Pare nt ho od su bm it te d to th e

go ve rn m en t, le t al on e an y rep res en ta ti ve ex am pl es .” D. Ct

. Ord er of Dec. 28

, 20 12

,

at 6.

II. Dis cu ss io n

W e r e v ie w de no vo a di st ric t co ur t’s de ci si on to di sm is s a co m pl ai nt un de r

Ru le 9(b ). In r e Baycol Pro ds . Li ti g., 7 32 F.3d 86 9, 8 74 (8t h C ir. 2 01 3) . The FC A

im po se s li ab il it y on th os e who kn owi ng ly “ pr es en t fal se cl ai m s, or cau se fal se cl ai m s

to be pr es en te d, to th e go ve rn m en t f o r p a ym e n t or ap pr ov al ; [k no win gl y ] us e fal se

st at em en ts

, or cau se fal se st at em en ts to be us ed

, to ge t a fal se cl ai m pa id or ap pr ov ed

by th e go ve rn m en t; o r c o ns pi re to de frau d th e go ve rn m en t, am on g ot he r th in gs .” 1

Uni te d St at es ex r e l

. R a yn or v. Nat’l Ru ral Uti ls

. Co op

. Fi n., Co rp

., 69 0 F.3 d 95 1,

95 5 (8 th Ci r. 20 12 ) (ci ti ng 31 U.S.C. § 37 29 (a)( 1) -(3 )). U n d e r th e FCA, pr iv at e

in di vi du al s are pe rm it te d “ t o b r i n g a ci vi l act io n in th e na m e of th e Uni te d St at es

Bec au se th e FCA an d th e IFCA are ne arl y id en ti cal

, cas e la w in te rp ret in g th e 1

FCA al so ap pl ie s to th e IFCA. See Eil be rt v. Pel ic an (In re Eil be r t )

, 16 2 F.3 d 52 3,

52 6 (8 th Cir . 19 98 ).

-3

-ag ai ns t th os e who vi ol at e th e [FCA]’ s pr ov is io ns .” Baycol Pro ds

. Lit ig

., 73 2 F.3 d at

87 4. Liab il it y un de r th e FCA at ta ch es “ no t to th e un de rlyin g frau du le nt act iv it y

, bu t

to th e cl ai m fo r pa y m en t.” Id

. at 87 5 (q uo ti ng Co st ne r v. URS Co ns ul ta nt s, In c., 15 3

F.3 d 6 67 , 67 7 (8 th Cir . 19 98 )).

A. Plea di ng Sta nd ard Und er t he FCA

“ Bec au se th e FCA is an an ti -fra ud st at ut e, co m pl ai nt s al le gi ng vi ol at io ns of th e

FCA m us t co m pl y wit h Ru le 9( b) .” Jo sh i, 44 1 F.3 d at 55 6. Ru le 9( b) req ui res a pa rty

a ll eg in g frau d to “ st at e wit h pa rti cu la rit y th e ci rcu m st an ces co ns ti tu ti ng fr a u d [

. ]”

“ Thi s pa rti cu la rit y req ui rem en t de m an ds a hi gh er de gr ee of no ti ce th an th at req ui red

fo r ot he r cl ai m s.” Uni te d Stat es ex rel

. Co st ne r v. Unit ed St at es

, 31 7 F.3 d 88 3, 88 8

(8 th Cir . 20 03 ).

W e ex pl ai ne d in Jo sh i th at to sa ti sf y Ru le 9( b) ’s pa rti cu la rit y req ui rem en t, “ th e

co m pl ai nt m us t pl ead s u c h f

act s as th e ti m e, pl ace, an d co nt en t of th e de fen da nt ’s

f a ls e rep res en ta ti on s, as well as th e de ta il s of th e de fen da nt ’s frau du le nt a c t s

,

in cl ud in g whe n th e act s oc cu rr e d

, w h o e n ga ge d in th em , a nd wha t was ob ta in ed as

a res ul t.” 44 1 F.3 d a t 55 6. In ot he r wor ds

, “ th e co m pl ai nt m us t id en ti fy th e ‘w ho

,

wha t, whe re, wh en , and ho w’ of t he all eg ed frau d.” Id . ( qu ot in g Co st ne r, 31 7 F.3 d

at 88 8) . Mor eo ve r, we st at ed th at alt ho ug h a n F CA co m pl ai nt ne ed no t i nc lu de th e

“ sp eci fic de ta il s of ever

y al le ge d frau du le nt cl ai m ” whe n a rel a t o r al le ge s th at a

de fen da nt en ga ge d in a syste m at ic pr act ic e or sc he m e of subm itt ing fr au dul en t cl ai m s,

th e co mp l a i n t “ m

us t pr ov id e so me rep res en ta ti ve ex am pl es of [th e de fen da nt ’s]

al le ge d frau du le nt co nd uc t, sp eci fy in g th e ti m e, pl ace, an d co nt en t of [th e

de fen da nt ’s] act s an d t he id en ti ty of th e act or s.” Id . at 5 57

.

Th ay er co nc ed es th at sh e di d no t pr ov id e an y rep res en ta ti ve ex am pl es of th e

fal se cl ai m s in th e co m

pl ai nt

. Sh e arg ue s, ho wev er, th at ne it he r Ru le 9( b) it se lf no r

Jo sh i req ui res th at rep res en ta ti ve ex am pl es be pl ead ed in ev ery FCA co m pl ai nt th at

-4

-a l l e g e s a syste m at ic pr act ic e or sc he m e of su bm it ti ng fal se cl ai m s. W e ag ree, a n d

co nc lu de th at Jo sh i’s rep res en ta ti ve -ex am pl es req ui rem en t ne ed no t be sa ti sf ie d wit h

res pe ct to so m e p or ti on s o f th e co m pl ai nt

.

Dr. Jo sh i was an an es th es io lo gi st who ha d pr act ic ed at St

. Luk e’s Hos p it al

fro m 19 89 to 19 96

. Id

. at 55 4. His Apr il 20 04 qu i ta m act io n ag ai ns t th e ho sp it al an d

th e h os pi ta l’s ch ie f of an es th es io lo gy al le ge d, am on g ot he r th in gs , th at th e h os pi ta l

ha d syste m at ic al ly vi ol at ed th e FCA ov er a si xt een -y ear pe rio d by se ek in g Med ic are

rei m bu rs em en ts at hi gh er rat es th an th os e to whi ch it was en ti tl ed an d by su bm it ti ng

cl ai m s fo r se rv ic es th at were no t pe rfo rm ed an d su pp li es th at were no t pr ov id ed

. Id

.

at 55 4, 55 7. He di d no t id en ti fy th e de ta il s of an y of th e fal se cl ai m s in hi s co m pl ai nt

bu t in st ead al le ge d th at ev ery cl ai m su bm it te d was frau du le nt

. Id

. at 55 4- 5 6

. In

co nc lu di ng th at th e co m

pl ai nt fai le d to s a t i s f

y Ru le 9( b)

, we ex pl ai ne d th at “ Dr.

Jo sh i’s al le ga ti on th at ‘every’ cl ai m su bm it te d by St

. Luk e’s was frau du le nt la ck [ed ]

su ffi ci en t ‘ind ic ia of rel ia bi li ty[,] ’” id

. at 55 7, be cau se

, as an an es th es io lo gi st rat he r

th an a m em

b e r of th e ho sp it al ’s bi ll in g de pa rtment, he fai le d to pr ov id e th e fact ua l

ba si s fo r hi s “ kn owl ed ge co nc ern in g th e al le ge d su bm is si on of frau du le nt cl ai m s,” id

.

at 55 8. W e he ld th at to sa ti sf y Ru l e 9 ( b )

, h e w a s req ui red to pl ead at le as t so m e

rep res en ta ti ve ex am

pl es of t he fal se cla im s. Id . at 5 57

.

Unl ik e Dr. Jo sh i, who ha d no di rect co nn ect io n to th e ho sp it al ’s bi ll in g or

cl ai m s de pa rtment an d co ul d on ly sp ecu la te th at fal se cl ai m s were su bm it te d, Tha y er

was th e cen te r man a g er fo r two of Pl an ne d Pare nt ho od ’s cl in ic s, ov ers aw Pl an ne d

Pare nt ho od ’s bi ll in g a nd cla im s s y st em s, an d was ab le to pl ead pe rs on al , firs t-h an d

kn owl ed ge of Pl an n e d Pare nt ho od ’s su bm is si on of fal se cl ai m s. In th es e

ci rcu m st an ces

, we fin d pe rs ua si ve th e ap pr oa ch of th os e ci rcu it s th at ha ve co nc lu de d

th at a rel at or can sa ti sf

y Ru l e 9 ( b) by “ al le gi ng pa rti cu la r de ta il s of a sc he m e to

su bm it fal se cl ai m s pa ire d wit h rel ia bl e in di ci a th at le ad to a s t r o n g in fere nc e th at

-5

-c l a i ms w e re act ua ll y su bm it te d.” Uni te d St at es ex rel . Gr ub bs v. Kan ne ga nt i, 5 6 5 2

F.3 d 18 0, 19 0 (5 th Ci r. 20 09 ); se e al so Ch es br ou gh v. VPA, P.C., 65 5 F.3 d 46 1, 47 1

(6 th Ci r. 20 11 ); Ebei d ex rel. Unit ed St at es v. Lu ng wit z, 61 6 F .3d 99 3, 9 98 -9 9 (9t h

Ci r. 20 10 ); Uni te d St at es ex rel

. Lem m on v. Env iro care of Utah

, In c., 61 4 F.3 d 11 63

,

11 72 (1 0t h Ci r. 20 10 ); cf. Uni te d St at es ex rel

. Nath an v. Tak ed a Ph arm

. N. Am

., In c.,

70 7 F.3 d 45 1, 45 7 (4 th Ci r. 20 13 ) (in di cat in g th at a rel at o r n e e d n o t id en ti fy

in di vi du al fal se cl ai m s in or de r to sa ti sf y Ru le 9( b) if th e “ sp eci fic al le ga ti on s of th e

de fen da nt ’s frau du le nt co nd uc t ne ces sa ril y le d to th e pl au si bl e in fere n c e th at fal se

cl ai m s were pr es en te d to th e go ve rn m en t[,]” bu t th at rep res en ta ti ve ex am pl es are

req ui red if a de fen da nt ’s act io ns “ co ul d ha ve le d, bu t ne ed no t ne ces sa ri ly ha ve le d,

to th e su bm is si on of fa l s e c l a im s” ), cert

. de ni ed

, 13 4 S. Ct

. 17 59 (2 01 4) ; Uni te d

St at es ex rel

. Dux bu ry v. Orth o Bi ot ech Pro ds

., L.P., 57 9 F.3 d 13

, 29 (1 st Ci r. 20 09 )

(ex pl ai ni ng th at in qu i ta m act io ns in wh i c h th e de fen da nt al le ge dl y cau se d th ird

pa rti es to fil e fal se cl ai m s, “ a rel at or co ul d sa ti sf y Ru le 9( b) by pr ov id in g ‘factu al or

st at is ti cal ev id en ce t o s tre ng th en th e in fere nc e o f frau d b ey on d p os si bi li ty’ wit ho ut

ne ces sa ril y pr ov id in g de ta il s as to each fal se cl ai m ”); Uni te d Stat es ex rel

. Lus by v.

Ro ll s- Ro y ce Co rp ., 5 70 F.3 d 8 49 , 8 54 (7 th Ci r. 20 09 ) (“ W e do n’t th in k it es se nt ia l

fo r a rel at or to pr od uc e th e in vo ic es (an d acco m pa nyin g rep res en ta ti on s) at th e ou ts et

of th e su it .”); Co rs e l l o v

. Lin care

, In c., 42 8 F.3 d 10 08

, 10 12 (1 1t h Ci r. 20 05 ) (p er

c ur ia m ) (s ta ti ng th at to sa ti sf y Ru le 9( b)

, an FCA “ co m pl ai nt m us t co nt ai n ‘some

Pl an ne d Pare nt ho od arg ue s th at be cau se we ha ve co nt in ue d to req ui re rel at or s 2

to pl ead rep res en ta ti ve ex am pl es of th e fal se cl ai m s in or de r to sa ti sf y Ru le 9( b) in

cas es fo ll owi ng Jo sh i, we sh ou ld no t ex cu se Tha y er’s fai lu re to pl ead rep res en ta ti ve

ex am pl es

. See Un i t e d S t a te s ex rel . Du nn v. N. M em ’l He al th Care , 7 39 F.3 d 41 7,

42 0 (8 th Ci r. 20 14 ); Baycol Pro ds . Li ti g., 73 2 F.3 d at 8 7 8 -8 0; Uni te d St at es ex rel

. Ketr os er v. Mayo Fo un d., 72 9 F.3 d 82 5, 82 9 (8 th Ci r. 20 13 ); Un it ed St at es ex rel

. Vig il v. Neln et

, In c., 63 9 F.3 d 79 1, 79 7- 98 (8 th Ci r. 20 11 ); Uni te d St at es ex rel

. Ro op

v. Hy po gu ard USA, In c., 55 9 F.3 d 81 8, 82 2- 25 (8 th Ci r. 20 09 ). Lik e Jo sh i, ho wev er,

th es e cas es are di st in gu is ha bl e be cau se th e rel at or s di d n o t h a v e a c ces s to th e

de fen da nt s’ bi ll in g syste m s an d were no t a b l e to pl ead pe rs on al kn owl ed ge of th e

de fen da nt s’ su bm is si on of f al se cla im s.

-6

-in di ci a of rel ia bi li ty’ ” to su pp or t th e al le ga ti on th at a fal se cl ai m was su bm it te d to th e

go ve rn m en t).

As Ju dg e Hig gi nb ot ha m ex pl ic at ed in Gru bb s, Ru l e 9 ( b ) “ is co nt ex t sp eci fic

an d flex ib le an d m

us t rem ai n so to ach ie ve th e rem ed ia l pu rp os e of th e Fal se Cl ai m

Act.” See 56 5 F.3 d at 19 0. All owi ng a rel at or to sa ti sf y Ru le 9 ( b ) b y pl ead in g th e

“ pa rti cu la r de ta il s of a sc he m e to su bm it fal se cl ai m s pa ire d wit h rel ia bl e in di ci a th at

le ad to a st ro ng in fere nc e th at cl ai m s were act ua ll y su bm it te d” fu lfi ll s th e ob jecti ve s

of Ru le 9( b) “ wit ho ut st y m ie in g le gi ti mat e e f f o rts to ex po se frau d.” Id

. The se

ob jecti ve s in cl ud e bo th pr ov id in g th e de fen da nt wit h ad eq ua te no ti ce of th e rel at or ’s

cl ai m s an d p ro te ct in g t he de fen da nt fro m ba se le ss cla im s. Id

. at 19 0- 91

. W e ag ree

th at “ [s ]tati ng ‘w it h pa rti cu la rit y th e ci rcu m st an ces co ns ti tu ti ng frau d’ do es no t

ne ces sa ril y

an d a lways m ean st at in g t he co nt en ts of a bi ll .” Id . at 1 90

.

Giv e n R u l e 9( b) ’s ob

jecti ve of pr ot ect in g de fen da nt s fro m ba se le ss cl ai m s,

rel at or s who se all eg at io ns la ck su ffi ci en t in di ci a of rel ia bi li ty sh ou ld be req ui red to

pl ead rep res en ta ti ve ex am pl es of th e fal se cl ai m s be cau se th ei r al le ga ti on s are m or e

li ke ly to be un fo un de d. In co nt ras t

, a r el at or who pr ov id es su ffi ci en t in di ci a of

rel ia bi li ty to su pp or t he r al le ga ti on s th at fal se cl ai m s were su bm it te d, s uc h as by

pl ead in g de ta il s ab ou t th e de fen da n t ’s b i l li ng pr act ic es an d pl ead in g pe rs on al

kn owl ed ge of th e de fen da nt ’s su bmi s s io n of fal se cl ai m s, fu lfi ll s Ru le 9( b) ’s

ob jecti ve of pr ot ect in g th e de fen da nt f r o m b as el es s cl ai m s. Acco rd in gl y

, we

conc lu de th at a rel at or can sa ti sf y Ru le 9( b) wit ho ut pl ead in g rep res en ta ti ve ex am ples

o f fal se cl ai m s if th e rel at or can ot he rwis e pl ead th e “ pa rti cu la r de ta il s of a sc h e me

to su bm it fal se cl ai m s pa ire d wit h rel ia bl e in di ci a th at le ad to a st ro ng in fere nc e th at

cl ai m s were act ua ll y su bm it te d.” Id

. To sa ti sf y th e “ pa rti cu la r de ta il s” req ui rem en t

of ou r ho ld in g, ho wev er, th e r e l a t or m us t pr ov id e su ffi ci en t de ta il s “ to en ab le th e

de fen da nt to r e s p o nd sp eci fic al ly an d qu ic kl y to th e po te nt ia ll y da m ag in g

al le ga ti on s.” Uni te d S ta te s ex rel . Cos tn er v

. Uni te d Stat es

, 31 7 F.3d 88 3, 88 8 (8t h

Ci r. 20 03 ).

-7

-B. The C om pl ai nt

App lying th is st an da rd to th e al le ga ti on s in th e co m pl ai n t

, we co nc lu de th at

Tha y er ha s pl ed su ffi ci en tl y pa rti cu la riz e d fact s to su pp or t he r al le ga ti on s th at

Pl an ne d Pare nt ho od vi ol at ed th e FCA by fil in g cl ai m s fo r (1 ) un ne ces sa ry qu an ti ti es

of bi rth co nt ro l pi ll s, (2 ) bi rth co nt ro l pi ll s di sp en se d wit ho ut ex am in at io ns or wit ho ut

or pr io r to a ph y si ci an ’s or de r, (3 ) ab or ti on -rel at ed se rv ic es

, an d (4 ) th e fu ll am ou nt

of se rv ic es th at h a d a l read y be en pa id

, in who le or in pa rt, by “ do na ti on s” Pl an ne d

Pare nt ho od co erce d fro m p a t i e n ts

. Tha y er ad eq ua te ly al le ge s th e pa rti cu la r de ta il s

of th es e sc he m es

, su ch as th e na m es of th e in di vi du al s th at in st ru ct ed he r to carr y ou t

th es e sc he m es

, th e two -y ear ti m e pe rio d in whi ch th es e s c he m es to ok pl ace, th e

cl in ic s t ha t p art ic ip at ed in th es e sc he m es , and th e m et ho ds by w hi ch th es e sc he m es

were pe rp et rat ed

. Mo reo ve r, sh e al le ge s th at he r po si ti on as cen te r m an ag er ga ve he r

acce ss t o P l an ne d Pare nt ho od ’s cen tra li zed bi ll in g syste m

, pl ead s sp eci fic de ta il s

ab ou t Pl an ne d P aren th oo d’s bi ll in g syste m s an d pr act ic es

, an d al le ge s th at sh e ha d

pe rs on al kn owl ed ge of P la nn ed Pare nt ho od ’s s ub m is si on of f al se cla im s. Th ay er’s

cl ai m s th us ha ve su ffi ci en t in di ci a of rel ia bi li ty be cau se sh e pr ov id ed th e un de rlyin g

fact ua l bas es fo r he r al le ga ti on s. See Co rs el lo

, 42 8 F.3d at 10 12 -1 4 (de sc rib in g th e

in di ci a of rel ia bi li ty req ui red un de r Ru le 9( b) ). Acco rd in gl y

, be cau se Tha y er pl ead ed

th e pa rti cu la r de ta il s of th es e sc he m es as well as th e ba se s fo r he r kn owl ed ge of th es e

de ta il s, t h es e al le ga ti on s are su ffi ci en t to wit hs ta nd Ru le 9( b) ’s pa rti cu la rit y

req ui rem en t.

Tha y er’s al le ga ti on s th at Pl an ne d Pare nt ho od vi ol at ed th e F C A b y cau si ng

ot he r ho sp it al s to un kn owi ng ly su bm it cl ai m s fo r ab or ti on -rel at ed se r v i c e s an d by

up co di ng

, ho wev er, are no t su ffi ci en t to s a t i s f y R u le 9( b)

. W e ad dr es s th es e

al le ga ti on s i n t ur n.

-8

-1. Ca us in g Ot he r Hos pi ta ls to Su bm it Fal se Cla im s

As se t fo rth ab ov e, Tha y er co nt en ds th at Pl an ne d Pare nt ho od vi ol at ed th e FCA

by in st ru ct in g pa ti en ts who ex pe rie nc ed ab or ti on -rel at ed co m pl ic at io ns to gi ve fal se

in fo rm at io n to m ed ic al pr of es si on al s at ot he r ho sp it al s, cau si ng th os e m ed ic al

pr of es si on al s to un kn owi ng ly file cla im s for serv ic es pe rfo rm ed in co nn ect io n with

ab or ti on s. S pe ci fic al ly, Tha y er al le ge s th at Pl an ne d Pare nt ho od ’s cl in ic pe rs on ne l

were in st ru ct ed to te ll pa ti en ts who rece iv ed ab or ti on s “ to rep or t to th e lo cal ho sp it al

em erg en cy ro om in cas e of he m or rh ag e or ot he r se rio us si de effe ct an d to ad vi se lo cal

ho sp it al em erg e nc y ro om pe rs on ne l th at [th ey ] ha d su ffer ed a ‘m is carr ia ge ’ an d to

se ek Tit le XIX-Me di cai d co ve rag e fo r su ch ‘m is carr ia ge .’ ” Tha y er fu rth er al le ge s

th at sh e le arn ed th at fal se cl ai m s were su bs eq ue nt ly fil ed by lo cal ho sp it al s “ as a

di rect res ul t of Pl an ne d Pare nt ho od [’s]

. . . in st ru ct io ns to cl ie nt s t o f a l s e l y te ll th e

ho sp i ta ls th at th ey were m erel y su ffer in g a m is carr ia ge .” The se al le ga ti on s fai l to

sa ti sf y Ru le 9( b) be cau se th ey la ck su ffi ci en t in di ci a of rel ia bi li ty. Tha y er do es no t

al le ge th at sh e ha d acce ss to th e bi ll in g syste m s of th e un id en ti fie d lo cal ho sp it al s, no r

do es sh e co nt en d th at sh e ha d kn owl ed ge of th ei r bi ll in g pr act ic es

. As a res u l t,

Tha y er is on ly ab le to sp ecu la te th at fal se cl ai m s were su bm it te d by th es e ho sp it al s.

Bec au se Tha y er fail ed to pro vi de a fact ua l bas is fo r he r kn owl ed ge of th es e al le ge d

fal se cl ai m s, we are un a b l e t o in fer th at fal se cl ai m s were su bm it te d. Acco rd in gl y

,

we affi rm th e d is m is sa l o f th es e al le ga ti on s.

2. Up co di ng

The co m pl ai nt a l l e g e s th at Pl an ne d Pare nt ho od sc he du le d la rg e nu m be rs of

cl ie nt s fo r vi si ts du rin g th e sh or t win do ws of ti m e in whi ch ph y s ic ia ns wou ld be

av ai la bl e at th e cl in ic s. Th ay er co nt en ds th at Pl an ne d Paren th oo d th en vi ol at ed th e

FCA by “ bi ll [in g] vi si t s

. . . a s pr ob le m vi si ts

, us in g CPT co de s 99 21 2- 99 21 5 (fo r

ex is ti ng pa ti en ts ) an d 99 20 1- 99 20 5 (fo r ne w pa ti en ts ) fo r se rv ic es pe rfo rm ed du rin g

th is win do w of ti m e ev en th ou gh th e ph y si ci an wou ld us ua ll y on ly br ie fly lo ok in to

-9

-th e ro om fro m th e ha ll way at th e cl ie nt or no t ev e n s ee th e cl ie nt [.]” In ad di ti on

,

Tha y er al le ge s t ha t Pl an ne d P aren th oo d u se d p ro bl em co de s i n b il li ng ev en “ whe re

th e cl ie nt ha d no m ed ic al pr ob le m an d was on ly se ek in g fam il y pl an ni ng se rv ic es [.]”

The se al le ga ti on s al so fai l to sa ti sf y R u l e 9 (b ). Alt ho ug h Tha y er is no t req ui red to

pl ead rep res en ta ti ve ex am pl es of th e fa l s e c la im s, sh e st il l is req ui red to pl ead th e

pa rti cu la r de ta il s of th e sc he m e to su bm it fal se cl ai m s. Th a y er’s co nc lu so ry an d

ge ne ral iz ed al le ga ti on s th at Pl an ne d Pare nt ho o d vi ol at ed th e FCA by en ga gi ng in

up co di ng do no t m eet th is req ui rem en t. Fo r ex am pl e, Tha y er fa il ed to al le ge whe n

or ho w of te n up co di ng to ok pl ace at th e va rio us cl in ic s, who or ho w m an y ph y si ci an s

en ga ge d in up co di ng

, or wha t types of s e r v i ces were in vo lv ed in th e up co di ng

sc he m e. Mo reo ve r, in st ead of al le gi ng wha t m on ie s were frau d u l e nt ly ob ta in ed as

a res ul t of th e al le ge d up co di ng

, Tha y er m erel y co nt en ds th at “ th e Uni te d St at es an d

Io wa ha ve be en da m ag ed in an am ou nt to be pr o v e n a t tri al .” W e th us affi rm th e

di sm is sa l o f Tha y er’s u pc od in g a ll eg at io ns

. 3

C. Fed eral Ru le of C iv il Pro ced ur e 1 2( b) (6 )

In ad di ti on to m eet in g Ru le 9( b) ’s pa rti c u l a rit y req ui rem en t, co m pl ai nt s

al le gi ng vi ol at io ns of th e FCA “ m us t co nt ai n su ffi ci en t fact ua l m at te r, a c c e p t e d as

tru e, to st at e a cl ai m to rel ie f th at is pl au si bl e on it s face .” Vig il

, 6 3 9 F.3 d at 79 6

(q uo ti ng Ash cro ft v. Iq ba l, 55 6 U.S. 66 2, 67 8 (2 00 9) ). In de pe nd en t of it s arg um en t

th at Tha y er’s al le ga ti on s fai l t o sa ti sf y Ru le 9( b)

, Pl an ne d Pare nt ho od as se rts th at

Tha y er’s cl ai m s s h o u l d b e di sm is se d be cau se sh e fai le d to st at e FCA cl ai m s as a

m at te r of la w. Sp eci fic al ly, Pl an ne d Pare nt ho od arg ue s th at th e co m pl ai nt sh ou ld be

di sm is se d be cau se (1 ) he r al le ga ti on s are ba se d on al le ge d reg ul at or y vi ol at io ns th at

can no t se rv e as ba se s fo r li ab il it y un de r th e FCA, (2 ) sh e fai le d to id en ti fy reg ul at io ns

In li gh t of th is co nc lu si on

, we ne ed no t ad dr es s Pl an ne d Pare nt ho od ’s 3

al te rn at iv e arg um en t th at

, at a m in im um

, th e up co d i n g a l le ga ti on s sh ou ld be

di sm is se d b ecau se Thayer fai le d t o fi le th os e al le ga ti on s u nd er s eal

.

-1 0-tha t pr ohi bit Pl an ne d Pare nt ho od ’s pr act ic es

, or (3 ) th e ap pl ic ab le reg ul at io ns ac tua lly

pe rm it Pl an ne d Pare nt ho od ’s co nd uc t. The di st ric t co ur t di d n ot co ns id er th es e

arg um en ts in li gh t of it s de ci si on to di sm is s th e co m pl a i n t o n t h e b as is of Tha y er’s

fai lu re to pl ead rep res en ta ti ve ex am pl es of th e fal se cl ai m s. On rem an d, th e di st ric t

co ur t sh ou ld co ns id er whe th er an y of Tha y er’s rem a in in g al le ga ti on s su rv iv e th es e

ch al le ng es

. Our ho ld in g wit h res pe ct to th e Ru le 9( b) is su e, ho wev er, sh ou ld no t be

read as in an y way ex pr es si ng a vi ew on Pl a n n e d P aren th oo d’s Ru le 12 (b )(6 )

arg um en ts

.

III. Co nc lu si on

Th e jud gm en t is affi rm ed in pa rt an d rev ers ed in pa rt. The cas e is rem an de d

to th e d is tri ct co ur t fo r fu rth er p ro ceed in gs co ns is te nt wit h t hi s o pi ni on

.

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