Whether Federal Rule of Civil Procedure 9(b) requires False Claims Act plaintiffs to identify specific false claim submissions when pleading a fraudulent billing scheme with particularity

No question identified. : 1. This case presents an important question that deeply divides the circuits: Whether Federal Rule of Civil Procedure 9(b)’s heightened pleading standard requires False Claims Act plaintiffs who plead a fraudulent billing scheme with particularity to also identify specific false claim submissions to avoid dismissal. The False Claims Act empowers private individuals (relators) to bring fraud actions on the Government’s behalf. See 31 U.S.C. § 3729 et seq. The statute imposes liability when a person knowingly, with reckless disregard, or with deliberate indifference, presents a false or fraudulent claim to the Government for payment or approval. See ibid. Because it is an anti-fraud statute, FCA claims are subject to Rule 9(b)’s heightened pleading standard, which requires that a party “state with particularity the circumstances constituting fraud.” Fed. R. Civ. P. 9(b). 2. Petitioner Barbara Senters began at respondent Quest Diagnostics as a human resources generalist in 2005 and was promoted to compliance officer in 2007. Add. 4. Quest sells diagnostic laboratory tests to various medical practices and providers. Ibid. As part of her job “making sure that Quest was billing the government, namely Medicare and Medicaid, for tests eligible for reimbursement,” petitioner observed Quest’s automated system intentionally cause doctors to unknowingly order tests they had not deliberately chosen or authorized for Government-insured patients. Add. 4. Quest then falsely certified that the tests “were medically indicated and necessary for the health of the patient” when submitting reimbursement claims to Medicare and Medicaid. See Add. 4-6 (quoting CMS Form 1500). Petitioner sued Quest on behalf of the United States and the State of Georgia in July 2010. Ibid. After nearly a decade of investigation, the United States declined to intervene and the complaint was unsealed. Ibid. 3. Respondent moved to dismiss. The District Court granted the motion solely because petitioner failed to plead “‘a representative false claim in which the services rendered were not “medically indicated and necessary for the health of the patient” and where the claim was submitted to the government for payment.” See Add. 7 (panel quoting District Court). The Eleventh Circuit affirmed, confirming the circuit’s precedent: “It is not enough to plead generally that false claims were submitted, nor may a relator merely point to improper practices of the defendant to support the inference that fraudulent claims were submitted because submission cannot be inferred from the circumstances.” Add. 9 (quoting Olhausen v. Arriva Med., LLC, 124 F.4th 851, 86061 (11th Cir. 2024) (per curiam); internal quotation marks omitted); see also ibid. (quoting Corsello v. Lincare, Inc., 428 F.3d 1008, 1014 (11th Cir. 2005), for proposition that “a relator must ‘allege the “who,” “what,” “when,” and “how” of fraudulent submissions to the government”); Corsello 428 F.3d at 1014 (“Underlying improper practices alone are insufficient to state a claim under the False Claims Act absent allegations that a specific fraudulent claim was in fact submitted to the government.”). The panel acknowledged that petitioner’s job “gave her access to the claims being submitted to the government and that she reviewed the claims billed to the government.” Add. 10-11. Yet even though she described the fraud scheme in detail and identified specific dates, amounts, and patients connected to the false claims, the panel concluded that she had not plausibly alleged an FCA claim. Ibid. The panel reasoned that, “even with ‘direct knowledge of the defendants’ billing and patient records,’ [she] ‘failed to provide any specific details regarding either the dates on or the frequency with which the defendants submitted false claims, the amounts of those claims, or the patients whose treatment served as the basis for the claims.” Ibid. (quoting United States ex rel. Sanchez v. Lymphatx, Inc., 596 F.