United States v. Suburban Home Physicians, 1:14-cv-02793

Relators (former Suburban Home Physicians employees) filed a qui tam FCA and AKS action alleging a widespread home-health referral and billing scheme involving Suburban (Doctors at Home), its owners (Jocelyn and Jerry Gumila), and numerous third-party home-health providers and individuals.
Alleged misconduct includes backdating and falsifying Medicare Form 485 certifications, upcoding, reciprocal patient referrals, and payments to referral sources ("Serenity") to induce referrals, resulting in false Medicare claims.
The Amended Complaint groups many defendants into broad categories (e.g., "Doctor at Home Defendants," "Comet/Miranda Defendants"), often failing to tie specific acts to particular defendants.
Multiple defendants moved to dismiss under Rules 12(b)(6) and 9(b), arguing the complaint lacks the factual particularity required for fraud-based claims and fails to plead requisite scienter and materiality.
The Court granted the motions to dismiss for the listed moving defendants for failure to plead claims with sufficient plausibility and Rule 9(b) particularity, while giving Relators leave to replead most dismissed claims.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether FCA claims plead falsity, materiality, and scienter	Relators allege defendants caused submission of false Medicare claims via backdated Forms 485 and upcoding	Defendants argue allegations are conclusory, lump defendants together, and lack specific acts or scienter tied to each defendant	Dismissed for failure to plausibly plead FCA elements and required particularity; leave to replead granted
Whether AKS claims plead remuneration and intent with particularity	Relators allege reciprocal referrals and payments to "Serenity" and exchanges of patients/Forms 485 constitute unlawful remuneration	Defendants contend no specific allegations of payments/remuneration, no identification of who paid/received, and insufficient scienter	Dismissed for failure to satisfy Rule 9(b) and to allege specific remuneration and intent; leave to replead granted in most instances
Whether group pleading (lumping defendants) suffices under Rule 9(b)	Relators rely on broad categories (e.g., "Doctor at Home Defendants") to attribute misconduct	Defendants argue such lumping fails to provide fair notice of who did what and violates Rule 9(b)	Court held lumping is inadequate; complaints must identify specific defendants and actions
Whether any claims dismissed without leave to amend	N/A (Relators requested leave to re-plead)	Some defendants argued leave should be denied	Court granted leave to re-plead for claims dismissed (except those dismissed without objection)

Bell Atl. Corp. v. Twombly, 550 U.S. 544 (pleading must provide fair notice and be plausible)
Ashcroft v. Iqbal, 556 U.S. 662 (plausibility standard for complaints)
Universal Health Servs., Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (FCA materiality and rigorous scienter standards)
Pirelli Armstrong Tire Corp. Retiree Med. Benefits Trust v. Walgreen Co., 631 F.3d 436 (Rule 9(b) requires who, what, when, where, and how for fraud allegations)
Vicom, Inc. v. Harbridge Merchant Servs., Inc., 20 F.3d 771 (complaint must inform each defendant of alleged participation in fraud)
Thulin v. Shopko Stores Operating Co., 771 F.3d 994 (FCA scienter requires actual knowledge, deliberate ignorance, or reckless disregard)
United States v. Patel, 778 F.3d 607 (AKS liability for kickbacks tied to physician certifications via Form 485)