Aetna, Inc. v. Pfizer, Inc.
712 F.3d 51
1st Cir.2013Background
- Aetna appealed a district court summary judgment that favored Pfizer and against Aetna on RICO and PIFS claims related to Neurontin off-label marketing.
- The coordinated MDL case alleged fraudulent marketing and resulting harms under RICO and Pennsylvania Insurance Fraud Statute (PIFS).
- The district court dismissed Guardian and Aetna's claims, including Aetna's PIFS claim, and granted summary judgment as to Aetna’s RICO claim, prompting this appeal.
- The appellate court previously found evidence of causation and damages sufficient to survive summary judgment in Kaiser and reversed/ remanded in related matters, guiding the present analysis.
- Aetna proffered aggregate statistical evidence plus circumstantial proof linking Pfizer’s marketing to increased off-label Neurontin prescriptions paid by Aetna; Pfizer argued lack of causation proof and over-reliance on aggregate data.
- The court reverses the district court on Aetna’s RICO claim and vacates the PIFS ruling, remanding for further proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether aggregate evidence supports but-for causation for RICO. | Aetna evidence shows Pfizer’s fraud increased off-label prescriptions paid by Aetna. | Pfizer contends aggregate proof insufficient to prove but-for causation. | Survives summary judgment; aggregate and circumstantial evidence support but-for causation. |
| Whether proximate causation is established for private RICO claim. | Aggregate evidence plus Rosenthal’s analysis shows causation from fraud to Aetna’s payments. | Lack of direct reliance on misrepresentations undermines causation. | Sufficient proximate causation; jury could find foreseeability and injury. |
| Whether Aetna showed economic injury to support RICO claim. | Evidence of ineffectiveness and alternative theories show economic injury. | Economic injury disputed; dependence on aggregate data is insufficient. | Evidence supports economic injury; jury could determine damages. |
| Whether the Pennsylvania Insurance Fraud Statute claim should be entertained given RICO ruling. | PIFS claim should proceed if RICO liability is found. | PIFS issue remains separate and unresolved. | Vacated as to PIFS; remand for further consideration consistent with ruling. |
Key Cases Cited
- Holmes v. S. Protection Sec. Corp., 503 U.S. 258 (1992) (proximate causation and the Holmes tests favoring liability under civil fraud schemes)
- Bridge v. Phoenix Bond & Indem. Co., 128 S. Ct. 2131 (2008) (agency-like causation and reliance principles in private RICO)
- BCS Servs., Inc. v. Heartwood 88, LLC, 637 F.3d 750 (7th Cir. 2011) (damages at the damages phase have relaxed proof requirements)
- Rockwood v. SKF USA Inc., 687 F.3d 1 (1st Cir. 2012) (standard for reversing summary judgment and evaluating genuine issues of material fact)