Opinion ID: 2976477
Heading Depth: 2
Heading Rank: 1

Heading: Claims under Subsection (a)(1)

Text: Ms. Marlar has failed to comply with Rule 9(b) for her claims under subsection (a)(1). We have previously held that an action under subsection (a)(1) requires proof that the alleged false or fraudulent claim was “presented” to the government. See, e.g., United States ex rel. Thacker v. Allison Engine Co., 471 F.3d 610, 614 (6th Cir. 2006); Sanderson, 447 F.3d at 877-78. Ms. Marlar has not pleaded any facts regarding whether the alleged false claims were in fact submitted to the government. Instead, Ms. Marlar relies on the general allegation, “[o]n information and belief,” that BWXT submitted purported false claims to the government, and that DOE paid BWXT a fee that was based in part of the purported false claims. We have held, however, that alleging “ ‘that the defendants must have submitted fraudulent claims’ to the government” does not satisfy a plaintiff’s duty to plead with particularity under Rule 9(b). See Sanderson, 447 F.3d at 878 (quoting United States ex rel. Joshi v. St. Luke’s Hosp., Inc., 441 F.3d 552, 557 (8th Cir. 2006)). Instead, a plaintiff must “identify [the] specific claims that were submitted to the United States,” which Ms. Marlar has failed to do. Id. at 877 (internal quotation marks and citation omitted). “A plaintiff may not describe a[n alleged fraudulent billing] scheme in detail but then allege simply and without any stated reason for his belief that claims requesting illegal payments must have been submitted, were likely submitted or should have been submitted to the Government. A plaintiff must provide some support for the allegation.” United States ex rel. Heater v. Holy Cross Hosp., Inc., 510 F. Supp. 2d 1027, 1034 (S.D. Fla. 2007) (internal quotation marks and citations omitted). No. 07-6051 Marlar, et al. v. BWXT Y-12 L.L.C. Page 6 Ms. Marlar asserts that she has provided sufficient detail regarding the facts on which she has based her “belief” that the false claims were actually submitted to the government. She admits that she does not know what happened to the purportedly false reports after they left her division. She alleges, however, “[o]n information and belief” that the purportedly false reports were provided by the Environment, Safety, and Health division to senior management. She then alleges “[o]n information and belief” that the certification forms provided by BWXT to DOE were based on the purportedly false reports. These allegations do not suffice. Ms. Marlar does not allege personal knowledge of the procedures through which BWXT compiled its Completion Forms, self-evaluation, or monthly reports that BWXT submitted to DOE. Ms. Marlar also fails to allege concrete facts, rather than inferences based “[o]n information and belief,” to establish that fraudulent claims were in fact, once compiled, submitted to the government. She has not provided dates on which the purportedly false certifications were submitted, nor has she alleged who submitted the purportedly false certifications, nor has she alleged any other “specific information about the [certifications] allegedly submitted.” See Bledsoe II, 501 F.3d 512-13. Indeed, worse yet, she has even failed to plead with specificity the allegations of which she allegedly has personal knowledge; she has not identified any of the patients whose medical records were allegedly incomplete, nor has she identified any of the non-medical, safety employees who were allegedly pressuring the medical employees to falsify medical records. While we have before suggested that we may “relax[]” the pleading requirement when “a relator demonstrates that he cannot allege the specifics of actual false claims that in all likelihood exist,” Bledsoe II, 501 F.3d at 504 n.12, this case does not call upon us to establish such an exception. Ms. Marlar does not allege a factual basis for her assertions that purportedly false records from OHS were used by Environment, Safety, and Health division management to complete reports, that those false reports were then provided to BWXT senior management, that BWXT senior management then used those reports to complete its certification requirements necessary for performance-based compensation under BWXT’s contract with DOE, and that BWXT then allegedly submitted those certifications to the government. The weakness of these allegations, and their consequent unfitness for an exception to the pleading requirement, is made clear when compared with the allegations in United States ex rel. Walker v. R&F Properties of Lake County, Inc., 433 F.3d 1349 (11th Cir. 2005). In that case, the plaintiff was a nurse practitioner. Walker, 433 F.3d at 1353. She alleged that her employer was bilking Medicare and Medicaid by submitting fraudulent bills. Id. The fraudulent scheme involved charging the government for services rendered by a nurse practitioner as “incident to the service of a physician,” and therefore being paid a higher fee, despite the fact that a physician was not physically present and only “available for consultation by pager and telephone.” Id. As proof that the services of a nurse practitioner were always so charged in submitted claims, the plaintiff alleged that she did not have her own billing code, which would be required if the services were properly billed as being delivered only by a nurse practitioner, that she was told each day “which doctor she would be billing under,” and that the office administrator had told her, after the plaintiff had asked why she did not have her own billing code, that the employer always billed nurse practitioners’ services as “incident to the service of a physician.” Id. at 1360. Ms. Marlar’s allegations do not come close to these concrete factual allegations that the Eleventh Circuit found permitted an inference that false claims were actually submitted to the government.