Whether physicians' prescribing decisions constitute an intervening cause in a civil RICO action against a drug manufacturer for overpayment of drugs, and whether the RICO injury of a primary victim is a direct result when it is the natural and foreseeable consequence of a fraudulent scheme

The Racketeer Influenced & Corrupt Organizations Act (“RICO ”) provides a private cause of action to “[a]ny person injured in his business or property by reason of a violation of ” 18 U.S.C. § 1962 . 18 U.S.C. § 1964. This Court has long held “by reason of” requires a showing of proximate caus e. Holmes v. Sec. Inv. Prot. Corp. , 503 U.S. 258 , 268 (1992) . In civil RICO actions against drug manufacturers for overpayment of drugs , a circuit split has developed over whether physicians ’ prescribing decision s defeat proximate cause. Three circuits have concluded that a physician’s decision do es not defeat proximate cause. Two circuits have concluded the opposite . Below , the Fourth Circuit joined the minority vie w. Additionally , the courts of appeals are fractured over whether , in the RICO proximate cause analysis, the foreseeability can support the directness of a RICO injury . Five circuits have held that foreseeability is part of proximate cause. One circuit has held that foreseeability has no bearing on proximate caus e at all . Four circuit s have adopted conflicting holding s, including the Fourth Circuit . The question s presented are: (1) Whether , in a civil RICO action against a drug manufacturer for overpayment of drugs , physicians ’ prescribing decision s constitute an intervening cause . (2) Whether the RICO injury of a primary and intended victim is a direct result of a scheme to defraud when it is the natural and foreseeable consequences of such scheme .