Opinion ID: 2786807
Heading Depth: 2
Heading Rank: 1

Heading: False Claims Act generally

Text: The False Claims Act (FCA or Act) is an expansive[] statute, intended to reach all types of fraud, without qualification, that might result in financial loss to the Government. Cook Cnty., Ill. v. United States ex rel. Chandler, 538 U.S. 119, 129 (2003) (internal quotation marks omitted). As relevant here, the Act proscribes knowingly present[ing], or caus[ing] to be presented, a false or fraudulent claim for payment or approval.10 31 U.S.C. § 3729(a)(1)(A). To be actionable, a false or fraudulent statement must be material to the government's decision to pay a claim. United States ex rel. Loughren v. Unum Grp., 613 F.3d 300, 307 (1st Cir. 2010). The Act's qui tam provisions authorize private individuals to sue on behalf of the United States in order to recover monies alleged to have been defrauded from the government. 31 U.S.C. § 3730(b); United States ex rel. Duxbury v. Ortho Biotech Prods., L.P., 719 F.3d 31, 33 (1st Cir. 2013). In defining the notion of falsity under the FCA, which the statute itself does not do, a number of circuits have developed 10 The statute provides that the terms 'knowing' and 'knowingly' . . . mean that a person, with respect to information . . . (i) has actual knowledge of the information; (ii) acts in deliberate ignorance of the truth or falsity of the information; or (iii) acts in reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b)(1)(A). No proof of specific intent to defraud is required. Id. § 3729(b)(1)(B). -13- two categories of false submissions: those that are factually false and those that are legally false. See, e.g., United States ex rel. Conner v. Salina Reg'l Health Ctr., Inc., 543 F.3d 1211, 1217 (10th Cir. 2008); Mikes v. Straus, 274 F.3d 687, 696–97 (2d Cir. 2001). Courts have further subdivided claims in the latter group based on whether they proceed on a theory of either implied or express certification of compliance with conditions of payment. See United States ex rel. Wilkins v. United Health Grp., Inc., 659 F.3d 295, 305–06 (3d Cir. 2011) (collecting cases). This circuit recently has eschewed distinctions between factually and legally false claims, and those between implied and express certification theories, reasoning that they create artificial barriers that obscure and distort [the statute's] requirements. United States ex rel. Hutcheson v. Blackstone Med., Inc., 647 F.3d 377, 385 (1st Cir. 2011). Instead, we take a broad view of what may constitute a false or fraudulent statement to avoid 'foreclos[ing] FCA liability in situations that Congress intended to fall within the Act's scope.' United States ex rel. Jones v. Brigham & Women's Hosp., 678 F.3d 72, 85 (1st Cir. 2012) (alteration in original) (quoting Hutcheson, 647 F.3d at 387). We ask simply whether the defendant, in submitting a claim for reimbursement, knowingly misrepresented compliance with a material precondition of payment. New York v. Amgen Inc., 652 F.3d 103, 110 (1st Cir. 2011). Preconditions of payment, which may be found in -14- sources such as statutes, regulations, and contracts, need not be expressly designated. Hutcheson, 647 F.3d at 387–88. Rather, the question whether a given requirement constitutes a precondition to payment is a fact-intensive and context-specific inquiry, Amgen, 652 F.3d at 111, involving a close reading of the foundational documents, or statutes and regulations, at issue. Cf. United States v. Sci. Applications Int'l Corp., 626 F.3d 1257, 1269 (D.C. Cir. 2010) [hereinafter SAIC] (The existence of express contractual language specifically linking compliance to eligibility for payment may well constitute dispositive evidence of materiality, but it is not . . . a necessary condition.).11