2009 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit 11-10-2009 

# C h arles Lob el v

. Ex pres s S cript s Inc P r e c e de nt i al or N on-P r e c e de nt i al : N on-P r e c e de nt i al D ocke t N o . 09-1047

F o llow thi s and a dd it ion al work s at : http://d i git alc ommon s .l a w . vi ll anova . e du/thir dc ir c uit_2009

Thi s de c i sion i s br ou ght t o you for f r e e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit at V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2009 D e c i sion s b y an author i z e d a dmini s tr at or of V i ll anova U nive r sity S choo l of L a

w Di git al Reposit ory

. F or mor e inform at ion, p le as e c ont a ct Be n j amin . C arl s on@l a

w . vi ll anova . e du . Re c omme nde d C it at ion " C h arle s L o bel v

. Expr e s s S cr ipts Inc " (2009). 2009 D e cisio n s . P ape r 273. http://d i git alc ommon s .l a

w . vi ll anova . e du/thir dc ir c uit_2009/273NOT P RE CE DE NT I AL UN I TED STATES CO UR T OF A PP EALS F O R T H E T H IR D C IR C U IT

____________ N o. 09- 1047

____________ U N IT E D S T A T E S , ex re l. CH AR LES L OB EL,

v. EXP RES S S CRI P TS , I NC. CH AR LES L OB EL, A p p e llan t.

____________ O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e E a ste rn D istric t o f P e n n sy lv a n ia ( D . C . N o. 05- cv- 02707) D i s t r i ctJ udge: H onor abl e J ohn P. Ful l am

____________ Subm i t t ed U nderT hi r d C i r cui tL A R 34. 1( a)

O ct ober29, 2009 B e f o re : S L O V IT E R , F U E N T E S , a n d H A R D IM A N , C i r cui tJudges .

( Fi l ed: N ovember10, 2009)

____________ OPI NI ON O F THE COURT

____________Th e Di s t r i c tCo u r th a d j u r i s d i c t i o n u n d e r2 8 U. S . C. § 1 3 3 1 a n d 3 1 U. S . C. 1 § 3732( a) . W e have j ur i s di ct i on under28 U . S. C . § 1291. 2 H A R D IM A N , C i r cui tJudge . C h a rle s L o b e l ap p e a ls f ro m a ju d g m e n t o f

th e D istric t C o u rt d ism iss in g h is a m e n d e d c o m p lain t p u rsu a n t to th e F a lse C laim s A c t, 31 U .S .C . § 3 7 2 9 , fo r f a ilu re to s t a t e a c l a i m. W e wi l l a f f i r m. I. B eca us e w e w r i t e fort he part i es , w e r ecountonl ythe es s ent i al fac t s . L obel w as empl oy ed as a pharm aci s tbyD efe ndantE xpr es s Scr i pt s , I nc. ( E SI ) . E SI i s an in d e p e n d e n t p h a rm a c yb e n e f it m a n a g e r th a t p ro v id e d m a il o rd e r p re sc rip tio n s to p a rticip a n ts in th e D e p a rtm e n t o f D e f e n se ’s T R IC A R E h e a lth p ro g ra m . F o llo w in g h is t erm i nat i on i n M ay2005, L obel s ued ES I cl ai m i ng the companyfai l ed t o compl yw i th 21 C . F. R . § 1306. 05, w hi ch r equi r es t hatal l pr es cr i pt i ons forcontr ol l ed s ubs t ance s be dat ed, sign ed , an d b ea r th e re g istrati o n n u m b er o f th e m ed ical pra cti ti o n er. A ft er the G ov ernm ent decl i ned t o int ervene in the case, E S I m ov ed to di sm i ss L o b e l’s a m e n d e d c o m p lain t p u rsu a n t to R u le 1 2 (b )(6 ) o f th e F e d e ra l R u les o f

C iv il P ro c e d u re . T h e D istric t C o u rt g ra n ted E S I’s m o tio n a n d L o b e l f iled th is tim e lya p p e a l, cl ai m i ng t hathi s amended compl ai ntadequa t el ypl eade d vi ol at i ons of s ect i ons 3729( a) ( 1) - ( 2) of the Fal s e C l ai m s A ctundertheor i es of expr es s and i m pl i ed cert i fi cat i on. 13 II. A s bot h part i es corr ect l ynot e, t o s t at e a c l ai m forfal s e ce r t i fi cat i on of compl i ance w i th a r egul at i on, a r el at orundert he Fal s e C l ai m s A ctm us tal l ege that : ( 1) defe ndant vi ol at ed the r egul at i on; ( 2) defe ndantcert i fi ed i t s compl i ance w i t h t he r egul at i on t o a fede r al pay ori n s pi t e of i t s vi ol at i on of the r egul at i on; and ( 3) defe ndant ’ s cert i fi cat i on of c o m p lia n c e w a s a c o n d itio n o f p a ym e n t. R o drig u ez v . O u r L a d y o f L o u rd e s Me d . C tr ., 552 F. 3d 297, 304 ( 3d C i r . 2008) . I n cons i der i ng L obel ’ s expr es s and i m pl i ed ce rt ifi ca ti o n claim s in this ap p ea l, w e f o cu s o n the th ir d fa ctor. W e r ej ectL obel ’ s expr es s cert i fi cat i on cl ai m outof hand. H i s amended compl ai nt fai l s t o i dent i fya s i ngl e cl ai m s ubm i t t ed byE SI i n w hi ch i tr epr es ent ed fa l s el yt o t he G o v e rn m e n t th a t itc o m p lied w ith re g u latio n s th a t af f e c t it s e lig ib ili tyf

o r p a ym e n t. T h is is plainlyinsu ff

ici en t un d er R odr iguez . S e e id . at303. A l though notas s peci ous as hi s expr es s cert i fi cat i on cl ai m , L obel ’ s i m pl i ed cert i fi cat i on ar gum ents uffe r s fr om obvi ous defe ct s . Fi r s t , L obel chal l enges the D i s t r i ct C our t ’ s j udgm entbyr el y i ng upon t he i ncorr ectl egal s t andar d. A tpages 9, 10, and 20 of hi s br i ef, L obel r el i es on t he Supr eme C our t ’ s deci s i on i n C onl ey v . G i bs on , 355 U . S. 41 ( 1957) . A s E SI r i ght l ycount er s , t he Supr eme C our toverrul ed C onl ey i n B e ll A tla n tic C o rp . v. T

w o m b ly , 550 U . S. 544, 555- 57 ( 2007) . M or eover , as the Supr eme C our tm ade cl earl as tt erm : “bar e as s ert i ons , ” “l egal concl us i ons , ” and “ form ul ai c r eci t at i on[s ] of the el ement s of a c aus e of a ct i on” ar e “notent i t l ed t o t he as s um pt i on of truth. ” A s hcr of tv.I n hi s R epl yB r i ef, L obel ar gues forthe fi r s tt i m e thatthe Fr aud Enfor cementand 2 R ecove ryA ctof 2009 has change d t he s t andar d. I ti s w el l es t abl i s hed thatar gum ent s not ra is e d in a n a p p e lla n t’ s o p e n in g b ri e f a re w a iv e d . See, e. g. , U n itedS ta tes v . P e lu llo , 399 F. 3d 197, 222 ( 3d C i r . 2005) . E ven had thi s ar gum entnotbeen w ai ved, i ts uffe r s fr om the sam e def

ectas the argu m ent w e rej ect ed o n the m eri t s. 4 I qbal , 129 S. C t . 1937, 1950- 51 ( 2009) . L obel ’ s fai l ur e eve n t o ci t e T w o m b ly and I

qbal in e ith e r o f

h is tw o b rie f

s is a tellin g o m iss io n . W h e n L o b e l’s a m e n d e d c o m p lain t is a n a ly z e d u n d e r th e m o re e x a c tin g sta n d a rd e sta b lish e d b yth o se c a se s, it fa lls w e ll sh o rt. L obel ci t es s even pa r agr aphs of hi s amended compl ai ntt o s uppor thi s ar gum ent thathe s t at ed a c l ai m upon w hi ch r el i ef maybe gr ant ed. T w o of thes e s even p a r a g r a p h s — p a r a g r a p h s 1 8 a n d 2 4

— me r e l yq u o t e th e F a l s e Cl a i ms Ac ta n d 2 1 C. F . R. § 1 3 0 6 . 0 5 . F o u r oth er p ara g rap h s— p ara g rap h s 1 7 , 2 5 , 2 6 , an d 2 7

— all eg e in c o n clus o ry fas hi on thatE SI vi ol at ed the Fal s e C l ai m s A ctbys ubm i t t i ng cl ai m s forpr es cr i pt i ons fil led in v iolati o n o f § 1 3 0 6 . 0 5 . U n d er I qbal , thes e conc l us oryal l egat i ons ar e not pr es um ed t o be true. 129 S. C t . at1950. L i kew i s e, par agr aph 28, w hi ch al l eges m at er i al i ty , i s a l egal concl us i on w hi ch the D i s t r i ctC our tw as notobl i ged t o acc eptas tru e . I d. a t1 9 4 9 . I n a d d i t i o n t o t h e s e f a c tu a l d e f

i c i e n c i e s , a f

t e rr e v i e wi n g th e r e c o r d , we 2 a g r e e wi th E S I t h a tt h e v i o l a t i o n o f § 1 3 0 6 . 0 5 L o b e l a l l e g e s c a n n o t , a s a ma t t e ro f l a w, g iv e rise to liab ili tyu n d e r th e F a lse C laim s A c t b e c a u se c o m p lian c e w ith th e re g u latio n is nota “c ondi t i on of paym ent . ” See Rodri guez , 552 F. 3d at304. III . F o r th e f o re g o in g re a so n s, w e w ill a f f irm th e ju d g m e n t o f

th e D istric t C o u rt.