Whether Federal Rule of Civil Procedure 9(b)'s heightened pleading standard requires False Claims Act plaintiffs to identify specific false claim submissions to the government when alleging a fraudulent billing scheme

No question identified. : 1. This case presents an important question that deeply divides the circuits over 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 identify specific false claim submissions to the government to avoid dismissal. The False Claims Act (FCA) empowers private individuals, known as relators, to bring actions alleging fraud on the government’s behalf. See 31 U.S.C. § 3729 et seq. The statute imposes liability when a person presents a claim for payment or approval to the government that is false or fraudulent and acts with knowledge, actual knowledge, or deliberate ignorance regarding the truth or falsity of the claim. See ibid. Because it is an anti-fraud statute, claims brought under the FCA are subject to the heightened pleading standard of Rule 9(b), which requires that a party “state with particularity the circumstances constituting fraud.” See Fed. R. Civ. P. 9(b). 2. Petitioners are three current and former physicians at Detroit-area hospitals who allege that their hospitals’ parent company, Tenet Healthcare Corporation, and subsidiary hospital system, Detroit Medical Center, fraudulently billed the government for inpatient care that patients did not and could not receive. Add. 1. Petitioner Erik Olsen, M.D., is an emergency room physician who has worked and trained at Detroit Medical Center hospitals since about 2004 and, until recently, practiced at Detroit Receiving Hospital. Add. 4. Petitioners Sajith Matthews, M.D., and William Berk, M.D., are both physicians who, like Olsen, still practice or once practiced at Detroit Medical Center hospitals. Ibid. Respondents are Tenet Healthcare Corporation and Detroit Medical Center. Petitioner Olsen filed the initial qui tam complaint under seal; after the United States and the State of Michigan declined to intervene, petitioners Olsen, Matthews, and Berk filed an amended complaint claiming that respondents violated the False Claims Act (FCA) and the Michigan Medicaid False Claims Act by knowingly presenting false or fraudulent claims for payment to government healthcare programs. See Add. 1, 4. Petitioners allege that respondents “fraudulently bill for inpatient care when patients are held in emergency room facilities (“ERs’), a practice 2 known as ‘boarding.” Add. 2 (quotation marks omitted). “These patients, with an inpatient admission order, are ‘boarded’ in the ER until either a bed in an inpatient unit becomes available, or the patient is discharged.” Ibid. Inpatient care is generally “administered at a higher level than the care required in ERs and is” therefore “reimbursed at higher rates, so boarded patients ‘ought to be billed as outpatient.” Ibid. (citation omitted). Based on their first-hand observations and experiences working within these hospitals, though, petitioners allege that respondents “routinely bill Medicare, Medicaid and other government healthcare programs for inpatient care that was not delivered or capable of being delivered at the [Detroit Medical Center]’s acute care hospitals’ emergency departments.” Add. 7 (quotation marks omitted). 3. Respondents filed a motion to dismiss the complaint, claiming that relators failed to satisfy Federal Rules of Civil Procedure 8(a), 9(b), or 12(b)(6). Add. 4. The district court granted respondents’ motion to dismiss. See Add. 5. The court rejected respondents’ argument that adding petitioners Matthews and Berk to the complaint violated the FCA’s first-to-file rule. See ibid. But the court reasoned that because petitioners had not alleged the details of any particular false or fraudulent submission to the government, petitioners thus failed to “sufficiently allege that [respondents] directly participated in the submission of any of the purported false claims” or “directed their subsidiary hospitals to bill government programs while knowing that, at the time the billing pe