After acquiring the medical records for N.B., a minor, Dr. Toby T. Watson initiated this qui torn False Claims Act suit against N.B’s former treating psychiatrist, Dr. Jennifer King-Vassel. While in King- *709 Vassel’s care, N.B. received Medicaid assistance that covered N.B.’s prescription drug costs. Watson alleged that several of King-Vassel’s off-label prescriptions to N.B. constituted false claims submitted to the United States government. The district court entered summary judgment in favor of King-Vassel due to Watson’s failure to name expert witnesses. The court determined that expert testimony was required to prove essential elements of his case. Disagreeing with the district court’s conclusion, we reverse.
I. Background
Dr. Toby T. Watson placed an advertisement in a Sheboygan, Wisconsin, newspaper soliciting minor Medicaid patients who had been prescribed any of a number of psychotropic medications. He placed the ad after researching qui tam actions and meeting the President of the Law Project for Psychiatric Rights (not coincidentally, the attorney who represented Watson before this court). Watson’s ad offered the opportunity to “participate in a possible Medicaid fraud suit” and to share in any recovery from the litigation.
> N.B.’s mother—Christine Maxwell Meyer—responded to the advertisement and eventually entered into an agreement with Watson to share the proceeds from the potential lawsuit. Though Watson had never treated, or apparently even met, N.B., Meyer agreed to procure a copy of N.B.’s medical records to facilitate the lawsuit. Toward this end, Meyer addressed to King-Vassel a signed authorization to disclose N.B.’s treatment records. The authorization stated that Meyer was requesting the records “[f]or the purpose of providing psychological services and for no other purpose whatsoever....” (R. 42-1 at 7.) The authorization did not mention litigation or any possible Medicaid fraud suit. (Id. at 7-8.)
Rather than providing psychological services to N.B., however, Watson combed the records for so-called “off-label” prescriptions. An “off-label” prescription is one written for a purpose that has not been approved by the Food and Drug Administration (“FDA”). . These purposes can, and often will, find support in scientific literature, but, for whatever reason, the drug’s manufacturer either has not, or has not yet, gone through the FDA approval process for that specific use. Once a drug has been approved for one use, however, the FDA cannot prevent physicians from prescribing the drug for other uses.
Cf. Buckman Co. v. Plaintiffs’ Legal Comm.,
King-Vassel treated N.B. between 2004 and 2008 and prescribed a number of psychotropic medications. Watson identified forty-nine individual prescriptions that he alleged constituted false claims to the United States government. Under the applicable interlocking provisions of the False Claims Act and laws governing Med *710 icaid, the federal government generally will not pay for medications prescribed for purposes not approved by the FDA or “supported” by any of several pharmaceutical reference books (called “compendia”). Watson theorized that the forty-nine prescriptions fit that description and filed suit in the Eastern District of Wisconsin against King-Vassel (as well as several other parties who have been dismissed) under the qui tam provision of the False Claims Act (“FCA”). Although the Department of Justice declined to intervene in the suit (as is its right in a qui tam action, though often indicative of a lower chance of success), Watson pressed ahead with the case.
On July 16, 2012, King-Vassel moved for summary judgment. King-Vassel’s summary judgment motion focused on two primary issues: whether Watson had “direct and independent knowledge” of the alleged Medicaid fraud (a prerequisite for qui tam standing), (R. 29 at 5), and whether the fraud allegations were based on publicly available information (a disqualifying factor for a qui tam FCA suit), (id. at 10). At the very end of her supporting brief, King-Vassel included a short, two-paragraph section arguing that the case should “be dismissed with prejudice” because Watson had failed to name an expert who could “discuss, among other things, how claims for reimbursement for medications are presented to Medicaid programs, and how payments are made by those Medicaid programs.” (Id. at 15.)
Watson’s brief in opposition to the summary judgment motion focused on the two primary issues that King-Vassel identified. (R. 42 at 2-6.) Watson also responded to the argument about expert testimony by arguing (1) that experts should not be required to explain the Medicaid payment system; and (2) that experts would not be required to explain the pharmaceutical aspects of the case (which relate, for reasons described below, to whether the claims would truly be “false” within the meaning of the FCA). (R. 42 at 6-8.) Again, this issue did not factor heavily in the briefing.
The district court ruled against KingVassel on her primary summary judgment arguments.
United States ex rel. Watson v. King-Vassel,
No. 11-CV-236,
II. Analysis
The district court granted summary judgment for King-Vassel on the issue of whether Watson was required to present expert witnesses with regard to two distinct parts of his case: (1) the Medicaid claim process, and (2) whether the claims Watson sued over were “false” within the meaning of the False Claims Act. Both of these issues are intimately entangled with the operation of the False Claims Act and Medicaid. Thus, we think a brief description of both will be helpful to the reader. We will proceed to address the issues in the order the district court analyzed them—the Medicaid process first, followed by the falsity of the claims—and delve deeper into Medicaid and the FCA at the appropriate times. For the reasons detailed below, we disagree with the district court’s entry of summary judgment.
*711
The False Claims Act makes it unlawful for a person to “knowingly present! ], or cause[] to be presented, a false or fraudulent claim for payment or approval” to the United States government. 31 U.S.C. § 3729(a)(1)(A). The Act establishes civil penalties for those who violate its terms; the penalties range from $5,000 to $10,000, “plus 3 times the amount of damages which the Government sustains.” 31 U.S.C. § 3729(a)(1)(G). Although the Attorney General can enforce these provisions, the Act also provides for enforcement through the empowerment of “private attorneys general.”
Stalley v. Methodist Healthcare,
Medicaid provides “medical assistance on behalf of families with dependent children and of ... individuals! ] whose income and resources are insufficient to meet the costs of necessary medical services.” 42 U.S.C. § 1396-1. Although the federal government ultimately foots much of the bill, the administration of the program is left to the states. In the case of prescription drugs, pharmacies pay pharmaceutical companies for drugs and then submit claims to the state Medicaid agency for reimbursement. 42 U.S.C. §§ 1396a(a)(23), (32). The federal government then reimburses the state. 42 U.S.C. § 1396-1. In that way, claims submitted to state Medicaid agencies are considered claims presented to the federal government and may serve as the basis for FCA liability.
See United States ex rel. Crews v. NCS Healthcare of III., Inc.,
With that bit of background out of the way, we proceed to the specifics of this case, which is before us on an appeal of the entry of summary judgment. ‘We review a district court’s grant of summary judgment
de novo,
drawing all reasonable inferences and viewing all facts in favor of the non-moving party.”
Fitzgerald v. San-toro,
The district court held that Watson’s failure to name expert witnesses meant that his evidence was insufficient to establish an essential element of his case.
King-Vassel,
A. Failure to Name a Medicaid Expert
The district court erred in granting summary judgment to King-Vassel on the basis of Watson’s failure to identify a Medicaid expert. To reach its conclusion, the district court began its analysis by describing the Medicaid process as a “black box” and the process of submitting claims as a “grand mystery.”
King-Vassel,
1. Dr. King-Vassel’s state of mind
Although the FCA uses the seemingly straightforward word “knowingly,” the statute’s state of mind element is actually quite nuanced. To establish liability under the FCA, the defendant must have acted with “actual knowledge,”
or
with “deliberate ignorance” or “reckless disregard” to the possibility that the submitted claim was false. 31 U.S.C. § 3729(a)(1)(A), (b). Therefore, while “[ijnnocent mistakes or negligence are not actionable under [the FCA],”
United States ex rel. Yannacopou-los v. Gen. Dynamics,
Though the FCA has contained the “reckless disregard” language for almost thirty years,
see United States ex rel. Williams v. Renal Care Grp., Inc.,
And here, based on those descriptions, we think that the district court was incorrect to hold that Watson could not, without an expert, “establish that KingVassel had any knowledge whatsoever of the likelihood of submission of a fraudulent claim.”
King-Vassel,
Specifically, Watson presented an affidavit from Christine Maxwell Meyer—N.B.’s mother—that asserted several facts that, if believed, could lead a rational jury to find that King-Vassel showed reckless disregard to the existence of a potentially false claim. For instance, Meyer affied that she had provided King-Vassel with N.B.’s Medicaid information. (R. 44 at 2.) Meyer further testified that she had never paid out of pocket for N.B.’s appointments with King-Vassel, and that King-Vassel had never “suggested that she had not billed Medicaid for her services to N.B.” (Id.) Relating to the prescriptions, Meyer testified that she “always used [her] medical assistance card to pay for N.B.’s medications” at the Wal-Mart pharmacy where the prescriptions were filled. (Id.) Watson additionally presented records from Wal-Mart that supported these claims. (R. 46-3.) And, Watson presented paperwork that seemed to indicate King-Vassel had been compensated by the Medicaid program for her prescriptions to N.B. (R. 46-4) (describing one of the services King-Vassel was paid for as “Medication Management”).
We would not describe any of these pieces of evidence as irrefutable proof of King-Vassel’s state of mind. And it is certainly the case that an expert’s testimony on Medicaid billing practices or standard doctor’s office procedure could make Watson’s case stronger. But including expert testimony would no doubt make many cases stronger. We do not think, however, that King-Vassel’s state of mind is beyond the common understanding of the lay juror. A reasonable jury could plausibly interpret the evidence Watson assembled to show that King-Vassel recklessly disregarded the fact that' N.B. received Medicaid assistance, 1 and that claims for *714 payment for his prescriptions would be submitted to Medicaid. Entry of summary judgment on this basis was therefore incorrect.
2. Proximate cause
The district court also determined that summary judgment was proper because of what it described as “a proximate-cause problem for Dr. Watson.”
Kiñg-Vassel,
Under Watson’s theory of the case, FCA liability extends to those persons or entities who actually cause the submission of a false claim to the United States government. 31 U.S.C. § 3729(a)(1)(A). Thus, an action that breaks the chain of causation would relieve a defendant of liability. Debates over proximate cause are certainly familiar to American civil jurisprudence.
See Palsgraf v. Long Island R.R. Co.,
We are not precisely certain what the district court meant when it described Medicaid as follows:
[T]here is a grand mystery between the time of the prescription and the claim being made to Medicaid. In many ways, that mystery is like a black box—perhaps Dr. King-Vassel’s signature on the prescription set off a series of reactions that on the other side of the box resulted in a false claim, but the churning mechanism on the inside is still a mystery.
King-Vassel,
B. Failure to Name a Medical Expert
The district court also faulted Watson for his failure to name a medical expert. Without such testimony, the court held, Watson could not prove the falsity of the alleged false claims, a fatal blow to his case.
King-Vassel,
Medicaid can only provide reimbursement for “covered outpatient drugs.” 42 U.S.C. §§ 1396b(i)(10), 1396r-8(a)(3). Covered drugs do not include any drugs “used for a medical indication which is not a medically accepted indication.” 42 U.S.C. § 1396r-8(k)(3). Watson’s theory was that King-Vassel prescribed medication to N.B. for reasons that were not medically accepted indications. Helpfully, “medically accepted indication” is a statutorily-defined term that refers to a prescription purpose approved by the Food, Drug, and Cosmetic Act, 21 U.S.C. § 301
et seq.,
or “supported by” any of several identified “compendia,” 42 U.S.C. § 1396r-8(k)(6), § 1396r-8(g)(l)(B)(i) (listing as approved “compendia” the American Hospital Formulary Service Drug Information, the United States Pharmacopeia-Drug Information (or its successor publications), and the DRUGDEX Information System). The prescriptions at issue are “off-label” and so the parties agree that the drugs were not prescribed for an indication covered under the FDCA. The district court’s ruling, therefore, centers around the “compendia.” These compendia are large reference books that contain a variety of information about the prescription phar-maceuticáls currently available on the American market—everything from their chemical makeup to potential side-effects to the age ranges of patients the drugs have been tested on.
See Edmonds v. Levine,
The district court concluded, rather summarily, that “medical documents typically are not readily understandable by the general public and would require an expert to explain their application to a particular set of circumstances.”
King-Vassel,
First, we note that King-Vassel did not move for summary judgment on the basis of Watson failing to present an expert who could explain the compendia. Rather, King-Vassel’s short, two-paragraph argument relating to expert witnesses focused on the need for “experts to discuss, among other things, how claims for reimbursement for medications are presented to Medicaid programs, and how payments are made by those Medicaid programs.” (R. 29 at 15.) In other words, King-Vassel’s motion relies entirely on the issues we disposed of above in Section II.A. “As a general matter, if the moving party does not raise an issue in support of its motion for summary judgment, the non-moving party is not required to present evidence on that point, and the district court should not rely on that ground in its decision.” Cloe v. City of Indianapolis, 712 F-.3d 1171, 1182 (7th Cir.2013) (citation omitted).
An exception to that general rule exists, however, when “the losing party is on notice that she has to come forward with all of her evidence.” Id. (citation omitted). The record is, at best, ambiguous as to whether this exception should apply here. The district court’s February 29, 2012, scheduling order required Watson to “name all expert witnesses and produce reports from expert witnesses” by April 11,'2012. (R. 24 at 1.) So Watson was certainly on notice that he had to name any required experts prior to King-Vas-sel’s July 16 motion for summary judgment. But there is nothing in the record giving Watson notice that the court would enter summary judgment because an expert was required to explain the compen-dia—a notion that neither the parties nor the district court seem to have considered prior to the short discussion in Watson’s opposition brief. (R. 42 at 7-8.) We think this theory is a thin reed on which to hang the entry of summary judgment.
We think that conclusion is especially appropriate because, viewing the record in the light most favorable to Watson, we are not convinced that an expert was necessarily required to explain the compendia with respect to each of Watson’s claims. Recall that an expert witness may be required when the ability to interpret the evidence presented is not within the capability of a lay juror. Watson wanted to present evidence that King-Vassel’s prescriptions to N.B. were not for a medically accepted indication that was supported by any of the statutorily-listed drug compendia. Again, the compendia provide
*717
a great deal of information about individual pharmaceuticals.
Edmonds,
The district court presumed that interpreting the compendia would be a far more complicated task, indeed one that would require a medical expert. At the summary judgment stage, when the court must view the record in the light most favorable to the nonmoving party,
Fitzgerald,
The district court may very well be correct that Watson requires an expert to explain some number of the prescriptions he charges constitute false claims. For instance, if N.B. was prescribed a specific drug to treat “anxiety,” and there is support in one of the compendia for prescribing the drug to treat “depression,” Watson would need to present expert testimony to prove that those two diagnoses are not coextensive. But the sweeping nature of the summary judgment order cut off all of Watson’s claims without regard to the specific facts underlying each one. And it did so despite the fact that King-Vassel had not moved for summary judgment on that basis. While the district court remains free to apply its reasoning in a more specific manner on remand (because, of course, Watson did not name any experts by the court’s deadline), we think the summary judgment order as .written was premature and overbroad.
Before concluding, we feel compelled to note that nothing in this opinion should be read to countenance the pre-suit actions of either Watson or his trial counsel: they dragged blameless parties into court unnecessarily and sought a medical release by representing that Watson was going to treat N.B.—“a total falsity.”
King-Vassel,
III. Conclusion
For the foregoing reasons, we REVERSE the district court’s grant of summary judgment, and REMAND for further proceedings consistent with this opinion.
Notes
. Meyer stated in the affidavit that "Dr. King knew that N.B. was on. Medicaid and knew that his care was being paid for by Medicaid.” (R. 44 at 2.) King-Vassel argues that this was speculation and beyond . Meyer's personal knowledge. (Appellee’s Br. at 17.) We agree *714 with King-Vassel on this point, and so do not rely on this particular statement to reach our conclusion. Nevertheless, the affied-to facts within the scope of Meyer’s personal knowledge—that Meyer had supplied King-Vassel with N.B.’s Medicaid information and had never paid out of pocket, for instance-—could give rise to the conclusion that King-Vassel had reason to know N.B.’s Medicaid status.
. Watson asks us to take judicial notice of a chart on one of the cited pages. His appellate counsel created this chart, purportedly based on the drug compendia, but Watson did not enter it into the district court record. His appellate counsel has attempted to enter this chart into the record in a separate case in another court. (Appellant’s Br. at 15 n. 28.) Regardless, we decline Watson's invitation.