Dist. Ct. did not err in granting defendant’s motion to dismiss plaintiff’s False Claims Act action alleging that defendant presented false/fraudulent claims for unnecessary medical services to U.S. govt. and State of Wisconsin, where basis for dismissal was Dist. Ct.’s belief that plaintiff had failed to sufficiently plead claim of fraud with particularity as required under Rule 9(b). Under heightened pleading requirements set forth in Rule 9(b), plaintiff must describe “who, what, when where and how” of alleged fraudulent conduct, and plaintiff’s allegations failed to meet said standard with respect to her claims regarding defendant’s evaluation process, mandatory drug screenings and policies on prescription refills and appointments, since she failed to allege any medical, technical or scientific context that would explain why defendant’s alleged actions amounted to unnecessary care. Plaintiff’s allegations also depended entirely on her personal estimation of fraudulent conduct that did not have sufficient foundation. However, plaintiff’s allegations were sufficient with respect to defendant’s alleged use of certain billing code for psychological services, where plaintiff alleged that defendant applied said code for services rendered by individuals whose job description did not include making psychological assessments. (Partial dissent filed.)
Federal 7th Circuit Court
Civil Court
False Claims Act