Opinion ID: 2743752
Heading Depth: 4
Heading Rank: 1

Heading: Claims Against BMS

Text: Schumann alleges he obtained direct and independent knowledge of his AKS and best-price claims against BMS in the same fashion. Specifically, he states in the CFAC that he learned of BMS’s allegedly improper conduct by reviewing confidential data fee and rebate agreements, discussing them with his Medco colleagues and BMS officials, and 19 negotiating their extension. In his supplemental declaration, Schumann repeats the bases for his knowledge mentioned in the CFAC, and adds that he reviewed confidential documents in Medco’s negotiation files, discussed them with colleagues, and understood that BMS was concerned the agreements would set a new best price for Coumadin. He also states that his experience led him to conclude that BMS could not have afforded to enter into the rebate and data fee agreements if it was complying with applicable anti-kickback and best-price statutes. None of these allegations is sufficient for Schumann to plead that he is an original source of the key components of his claims against BMS. First, knowledge of a scheme is not direct when it is gained by reviewing files and discussing the documents therein with individuals who actually participated in the memorialized events. See Paranich, 396 F.3d at 33536; Stinson, 944 F.2d at 1160-61. Second, Schumann’s description of his involvement in Medco’s business with BMS, including negotiating rebate and data fee agreements and recognizing that BMS was aware of its best-price reporting obligations, does not evince direct and independent knowledge of any improper kickback or inaccurate best-price report. See Paranich, 396 F.3d at 336 & n.11 (noting such knowledge gained when relator’s involvement constituted filing false claims on defendant’s behalf); Houck on behalf of the United States v. Folding Admin. Comm., 881 F.2d 494, 505 (7th Cir. 1989) (finding relator’s knowledge direct when he was involved by helping others file false claims); see also In re Pharmacy Benefit Mgrs. Antitrust Litig., 582 F.3d at 434 (explaining PBMs negotiate discounts and rebates from drug makers). Finally, Schumann’s conclusions that BMS intended to pay kickbacks to Medco and to submit false 20 claims to the government, based on his experience in and understanding of the PBM industry, do not qualify as independent knowledge under the FCA. See, e.g., United States ex rel. Zizic v. Q2Administrators, LLC, 728 F.3d 228, 240 (3d Cir. 2013) (“[W]e have repeatedly rejected the argument that a relator’s knowledge is independent when it is gained through the application of expertise to information publicly disclosed under § 3730(e)(4)(A).” (citing Atkinson, 473 F.3d at 526 n.27; Stinson, 944 F.2d at 1160)); see also Rockwell, 549 U.S. at 475-76 (rejecting FCA claim premised on relator correctly predicting submission of a false claim); United States ex rel. Vuyyuru v. Jadhav, 555 F.3d 337, 353 (4th Cir. 2009) (“[M]ere suspicion that there must be a false or fraudulent claim lurking around somewhere simply does not carry [relator’s] burden of proving that he is entitled to original source status.”). At bottom, then, the facts alleged in Schumann’s CFAC and supplemental declaration do not indicate he has direct and independent knowledge of BMS’s actual best price for Coumadin or how it was calculated; the inaccurate best price BMS reported to the government or how it was calculated, or any improper payments made to Medco or its health plans; or any false or fraudulent claim submitted or caused to be submitted by BMS. See Atkinson, 473 F.3d at 519-20. Therefore, Schumann does not qualify as an original source of his FCA claims against BMS.