Thulin v. Shopko Stores Operating Co., LLC

Dist. Ct. did not err in dismissing for failure to state valid cause of action plaintiff’s qui tam claim under False Claims Act, alleging that defendant over-billed Medicaid by submitting on behalf of dual-eligible customers bills for prescription drugs at higher Medicaid rates, even though defendant had initially submitted said bills to customers’ private insurance companies, which paid for said drugs at lower rates. Under False Claims Act, plaintiff was required to show that defendant’s claims to Medicaid were “false” or “fraudulent,” and he could not make such showing where, although Medicaid is only liable to extent that private insurance company had not paid said bills, instant bills at Medicaid rates were not “false” under State Medicaid Manual, where regulations contemplated that Medicaid would get billed for amounts beyond what it technically owed and would bear ultimate responsibility for not paying said bills when any over-billing occurred.