MEMORANDUM OPINION AND ORDER
Before the Court is
Defendant’s Motion to Dismiss Relator’s Complaint and Mem
I. Factual & Procedural Background
Relator John David Foster (“Relator” or “Foster”) brings this qui tam action against Defendant Bristol-Myers Squibb Company (“Defendant” or “BMS”), alleging violations of the Federal False Claims Act 1 (the “FCA”) and similar state statutes. 2 In plain terms, Foster accuses BMS of (1) giving illegal bribes and kickbacks to an HMO in order to induce doctors to prescribe BMS drugs; and (2) reporting inflated prices for those drugs to in order to avoid paying Medicaid rebates to the government.
A. The Factual Basis of Foster’s Claims
Foster previously worked for one of BMS’s competitors: the pharmaceutical company Parke-Davis. Foster was Parke-Davis’s National Account Manager for accounts in Texas and Louisiana from June 1998 through September 2000. In this position, he was responsible for selling pharmaceutical products to health maintenance organizations (“HMOs”) and other managed care entities. One such HMO was the Oschner Health Plan (“OHP”), which operated in Louisiana and the Eastern District of Texas. OHP was a large regional HMO, with approximately 200,000 individual members and some 700 affiliated doctors. One of Foster’s tasks at Parke-Davis was convincing OHP to give unrestricted formulary access to Parke-Davis’s cholesterol-lowering drug, Lipitor.
For the uninitiated, a formulary is a list of medications for which an HMO provides coverage.
J.B.D.L. Corp. v. Wyeth-Ayerst Laboratories, Inc.,
Foster claims that both Parke-Davis and BMS used such financial rewards to fight for position on OHP’s “very restrictive” formulary. (Relator’s Compl. at 9). Specifically, he explains that Parke-Davis’s Lipitor competed against BMS’s cholesterol-lowering drug, Pravachol — and
Foster claims that in negotiations that occurred between February 1998 and January 1999, various OHP representatives told him about incentives provided by BMS, including retroactive rebates; cash grants to OHP’s pharmacy department; and research grants, consulting and speaking fees, and other compensation given to the head of OHP’s Pharmacy and Therapeutics Committee, Dr. Richard Milani. (Relator’s Compl. at 11-15). Apparently, these incentives were better than those offered by Parke-Davis — and Pravachol maintained its place on the OHP formu-lary. Foster was told that Parke-Davis would have to beat BMS’s incentives before Lipitor would be added the formulary. However, Parke-Davis was unable to do so; BMS’s incentives were too great.
According to Foster, he learned the secret to BMS’s success in December 1998 from Vanessa Pappion, a BMS regional account representative. Pappion told Foster that BMS was able to offer such large discounts and bonuses to OHP (while still turning a profit) because BMS did not include the incentives in the “best price” amount it reported to Medicaid for Prava-chol and another drug called Glueophage. 3 By falsely inflating its “best price,” BMS reduced its obligation to pay Medicaid rebates. According to Foster, this scheme mitigated the cost of the OHP incentives. Foster claims that OHP’s pharmacy director, Tim Hambacher also described this practice to him in March 1999, stating that “the cash incentives provided by BMS effectively lowered the dose price of its products but was given in such a way as to not affect reports of ‘best price.’ ” (Relator’s Compl. at 15).
Plainly, appreciating these allegations requires some understanding of the Medicaid reimbursement program.
B. Medicaid Reimbursement
The Medicaid reimbursement program ensures that Medicaid has access to the same price discounts and deals received by commercial customers.
In re: Pharmaceutical Industry Average Wholesale Price Litigation,
Under the Medicaid rebate program, each drug manufacturer is required to report both the AMP and the Best Price for each of its covered drugs to the Centers for Medicare and Medicaid Services (“CMS”). Joel M. Androphy & Mark A. Correro, Whistleblower and Federal Qui Tam, IAtigaMonSuing the Corporation for Fraud, 45 S. Tex. L.Rev. 23, 39 (2003). CMS then calculates the unit rebate amount and reports it to the state Medicaid agencies. Id. The states then use the unit rebate amount, and data from pharmacies about prescription drug utilization during the quarter, to calculate the rebate owed to them by the drug manufacturer. Id. As such, the system depends on accurate reporting by drug manufacturers. But, that is exactly what Foster claims BMS failed to do.
C. Foster’s Allegations
(1) Best Price Claims
Foster’s primary allegation is that BMS did not accurately report its Best Price. He claims that from 1998 through 2002, BMS did not factor the financial incentives given to OHP into its Best Price reports— and, therefore, paid the state Medicaid programs less in rebates than what BMS actually owed.
(2) Kickback Claims
Additionally, Foster argues that the rebates, discounts, grants and other incentives paid by BMS were intended to make doctors prescribe BMS pharmaceuticals over other drugs. Foster argues that by paying financial incentives to OHP officials — and thereby obtaining a place on the OHP formulary — BMS “all but guarantee[d] that OHP doctors would prescribe Defendant’s drugs over competing products to OHP participants and nonparticipants alike.” Foster concludes that by doing so, BMS violated the Federal Anti-Kickback Statute (“AES”), 42 U.S.C. § 1320a-7b(b). The AKS “criminalizes the payment of kickbacks, bribes, or other inducements to doctors in an effort to influence decisions about prescriptions that are reimbursed by a federal health care program.”
Rost v. Pfizer,
(3)Section 3I0B Claims
Finally, Foster alleges that BMS submitted false claims by overcharging entities qualified by the government to purchase drugs at statutorily-defined discounted prices, pursuant to Section 256b of the Public Health Service Act, 42 U.S.C. §§ 201-300gg-92. As explained below, this claim depends on the charge that BMS reported false Best Prices to Medicaid.
The Public Health Service Act includes a drug discount program known as the “Sec
(4) Summary of the Claims
To summarize: Foster claims that BMS violated the False Claims Act in three ways: (1) by giving illegal kickbacks; (2) by submitting inflated Best Price reports; and (3) by overcharging federally-qualified entities covered by the Section 340B Program.
D. Procedural History
Based on these claims, Foster filed suit in this Court on March 31, 2005 under qui tarn provisions of the federal False Claims Act (the “FCA”) and the Texas, California, Illinois, Massachusetts, and Florida FCAs. Twenty months later, the United States gave notice that it did not intend to intervene in the case. The Court then ordered the complaint unsealed and authorized service on BMS. BMS subsequently filed the present motion to dismiss under Rule 12(b)(6). BMS argues that Foster’s claims should be dismissed for four reasons: (1) all claims (except those under the California FCA) are barred by the applicable statute of limitations; (2) the allegations are not stated with enough particularity to satisfy Federal Civil Procedure Rule 9(b); (3) the complaint does not allege the submission of a “false claim,” and therefore fails to state an actionable claim under the FCA; and (4) Foster has not complied with statutory service and filing requirements. Additionally, BMS argues that the Court should dismiss Foster’s claim under the Texas Medicaid Fraud Prevention Act (“Texas MFPA”) because the State of Texas has not intervened in the case.
II. Legal Standards
A. Rule 12(b)(6) Motion to Dismiss
To survive a Rule 12(b)(6) motion to dismiss a plaintiff must plead “enough facts to state a claim to relief that is plausible on its face.”
In re Katrina Canal Breaches Litigation,
When considering a 12(b)(6) motion to dismiss, the court must accept “all well-pleaded facts as true” and must view them “in the light most favorable to the plaintiff.”
In re Katrina Canal Breaches,
Mindful of these considerations, the Court now examines the substance of Defendant’s Motion to Dismiss.
III. ANALYSIS
A. The False Claims Act
The False Claims Act, 31 U.S.C. § 3729
et seq.,
prohibits the submission of false or fraudulent claims to the federal government.
United States ex rel. Karvelas v. Melrose-Wakefield Hospital,
Specifically, the FCA permits private individuals to sue, and recover damages on behalf of the United States, from any person who:
(1) knowingly presents, or causes to be presented, to an officer or employee of the United States Government ... a false or fraudulent claim for payment or approval; or
(2) knowingly makes, uses or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Government.
31 U.S.C. § 3729(a)(i )-(2). Additionally, the FCA imposes liability for ‘reverse claims;’ so-called because rather than making a claim for payment, the defendant makes a misrepresentation to the Govern
In the present case, Foster claims that BMS is liable for both direct and reverse false claims. His Kickback and Section 340B theories of liability allege direct false claims under Section 3729(a)(i )-(2); while his Best Price theory alleges reverse claims under Section 3729(a)(7). 6
It is important to remember that the focus in an FCA suit must be on the
false claim
itself. As the First Circuit has explained, “the FCA does not create a cause of action for
all
fraudulent conduct affecting the government.”
Rost,
B. Statute of Limitations
BMS first argues that Foster’s claims under the FCA, and his claims under the state FCA statutes (other than California), are time-barred and should be dismissed. BMS is entitled to make this argument in its 12(b)(6) motion to dismiss because a complaint that shows relief to be barred by the statute of limitations may properly be dismissed for failure to state a cause of action.
Kaiser Aluminum & Chemical Sales, Inc. v. Avondale Shipyards, Inc.,
(1) FCA Claims
Foster filed this lawsuit on March 31, 2005, alleging false claims made from January 1998 through the first quarter of 2002. BMS argues that these claims are barred under the applicable six-year statute of limitations. In response, Foster counters that his claims are timely because the applicable limitations period is actually ten years. The parties’ disagreement arises directly from the text of the FCA’s limitations provision, which states that an FCA lawsuit may not be brought:
(1) more than 6 years after the date on which the violation of [the FCA] is committed, or
(2) more than 3 years after the date when facts material to the right ofaction are known or reasonably should have been known by the official of the United States charged with responsibility to act in the circumstances, but in no event more than 10 years after the date on which the violation is committed,
whichever occurs last.
31 U.S.C. § 3731(b).
Foster’s assertion that he is entitled to a ten-year limitations period is based on the view that the equitable tolling provision codified in § 3731(b)(2) applies to relators and the government. BMS interprets the tolling provision to apply only to the government. Unfortunately for this Court, Fifth Circuit case law has not definitively established which interpretation is correct.
The only Fifth Circuit case to address the issue is
United States ex rel. Erskine v. Baker,
No. 99-50034,
Other courts disagree over the correct interpretation of § 3731(b)(2)’s tolling provision.
United States ex rel. Snapp, Inc. v. Ford Motor Co.,
Foster argues that the third school of thought is the correct interpretation of subsection(b)(2). He urges the Court to find that the statute of limitations was tolled until he gave the government notice of BMS’s alleged schemes by filing suit on March 31, 2005. Under this approach, the limitations period would date back to March 31, 1995 — and would include all of the alleged false claims.
For its part, BMS advocates for the first (and most restrictive) interpretation of subsection (b)(2) — that the tolling provision does not apply at all if the government does not intervene. Interpreted in this way, the statute of limitations would bar any false claim that occurred before March 31, 1999. Because Foster has alleged claims occurring from January 1998 through early 2002, BMS’s interpretation would bar at least some of his claims.
While
Erskine
is not binding precedent, its reasoning does provide this Court with guidance. In
Erskine,
the Court found that the language and legislative history of § 3731(b)(2) did not give the benefit of its tolling provision to relators. For this reason, the Court reckoned that subsection (b)(2) could only be available to relators if they were in direct identity with the government. At the same time, the Court stated the possibility of such a surrogate relationship between relator and government was foreclosed by Fifth Circuit precedent established in
United States ex rel. Foulds v. Texas Tech University,
The position advanced by Foster — that he should be given the benefit of Section 3731(b)(2)’s tolling provision without being subjected to its knowledge requirement— depends almost entirely on
Pogue,
a district court case from the D.C. Circuit.
Pogue,
This Court has thoroughly considered the text of the statute, the legislative history, and the case law cited above. Having done so, the Court is of the opinion that actions brought by a
qui torn
relator are governed by the limitations period in § 3731(b)(1).
Accord Erskine,
No. 99-50034,
That having been said, Foster has still alleged that BMS made numerous other false claims within the limitations period (from March 31, 1999 through 2002). Despite this fact, BMS argues that the Court’s determination that a six-year limitation period applies should result in the dismissal of all of Foster’s claims. The basis for this argument is that the remaining false claims alleged to have occurred within the statute are based on factual allegations of wrongdoing that occurred more than six years before Foster filed his complaint. (Def.’s Mot. at 19). In other words, the claims are inside the statute, but the factual basis for those claims is outside it.
“Little need be said” of BMS’s argument — it was rejected by the Fifth Circuit long ago in
Smith v. United States,
In an FCA suit, the limitations period is computed from “the date on which the violation of [the FCA] is committed.” § 3731(b)(1);
see Smith,
Here, Foster has alleged that false claims were submitted from March 31, 1999 through 2002 (within the 6 year statute of limitations). Because the limitations period begins to run from the date on which the false claim for payment was submitted to the government, these claims are not barred. BMS does not dispute that these claims are alleged to have occurred inside the statute; just that Foster has not pled sufficient facts to support the claims inside the statute. (See Def.’s Reply at 5-6). In this Court’s view, BMS’s argument that Foster’s factual deficiency is grounds for dismissing all of his claims is not a statute of limitations argument. Really, it is an argument about the sufficiency of the claims and the particularity with which they have been pled. This argument will be addressed below in the Court’s discussion of Foster’s pleadings.
In addition to his federal FCA claims, Foster has asserted causes of action under the analogous FCA statutes of Texas, Illinois, California, Florida, and Massachusetts. BMS asserts that the applicable statute of limitations under each of these state FCAs (except California’s) is as short as, or shorter than the federal statute. 7 Accordingly, BMS argues that the Texas, Illinois, Florida, and Massachusetts claims are time-barred and must be dismissed.
a) Illinois, Massachusetts & Florida FCAs
As Foster concedes, the Illinois and Massachusetts FCAs have six-years statutes of limitations that “mimic 31 U.S.C. § 3731(b).” Therefore, based on the analysis above, any false claims submitted before March 31, 1999 are time-barred under the Illinois and Massachusetts FCA and must be dismissed.
Similarly, Foster admits that the Florida FCA tracks the language of 31 U.S.C. § 3731(b), although its specific time limits are different. Under the version of the Florida FCA applicable at the time Foster filed his complaint, claims must be filed no more than five years after the date on which the violation was committed, or no more than 2 years after the material facts known by the government official charged with responsibility to act, but in no event more than 7 years after the date on which the violation is committed. Fla. Stat. § 68.089 (1994). 8 As such, based on the foregoing analysis of 31 U.S.C. § 3731(b), the Court concludes that the Florida FCA’s limitations period bars any false claims submitted before March 31, 2000.
b) Texas FCA
The Texas Medicaid Fraud Prevention Law (“Texas MFPL”) has no express limitations period. Tex. Hum. Res.Code Ann. §§ 36.001
et seq.
So, BMS asserts that Foster’s claims under that statute are governed the residual limitations period of Texas Civil Practice and Remedies Code § 16.051, which imposes a four-year limitations period from the day the cause of action accrues. Tex. Civ. Prac.
&
Rem. Code § 16.051. In opposition, Foster argues that this
qui tarn
lawsuit is a right of action belonging to the government and is therefore exempt from this four-year limitation. Tex. Civ. Prac & Rem.Code § 16.061 provides that a right of action of the state is not barred by Section 16.051. And, Foster argues, although the state has not intervened, this
qui tarn
is a right of action belonging to the government because “it is the government, not the relator, who is the real plaintiff in the suit.”
Riley v. St. Luke’s Episcopal Hosp.,
Therefore, because the state has not intervened, this right of action belongs to Foster-and is subject to the four-year statute of limitations in § 16.051. Any Texas FCA violations alleged to have occurred before March 31, 2001 are barred.
Furthermore and in the alternative, all of Foster’s Texas MFPL claims should be dismissed because the State of Texas did not intervene in the lawsuit within 60 days of receiving the complaint. According to Texas law in effect when Foster filed suit, “if the state declines to take over the [qui tarn] action, the court shall dismiss the action.” Tex. Hum. Res. Code § 36.104(b) (Vernon 1997). The Texas MFPL provides that “the state may elect to intervene and proceed with the action not later than the 60th day after the date the attorney general receives the petition and the material evidence and information;” Tex. Hum. Res.Code § 36.102(c) (Vernon 1997). So, if those 60 days have passed the state can no longer intervene and the claim should be dismissed.
Curiously, Foster argues that this 60-day period has not commenced because the state has not yet received the requisite “material evidence and information.” (Relator’s Resp. at 29). Yet Foster simultaneously claims that he has complied with the Texas MF Pl.’s service requirements, which require a qui tarn relator to serve the state with the petition and “substantially all material evidence and information.” Tex. Hum. Res.Code § 36.102(a) (Vernon 1997). Foster cannot have it both ways. If he properly served the state, then the state received the “material evidence and information” at least a year ago. 9 The 60-day period has now run and the State of Texas can no longer proceed with this action. Foster’s claims under the Texas MFPL must be dismissed. See Tex. Hum. Res.Code § 36.104 (Vernon 1997). 10
(3) Conclusion
Having analyzed the applicable statutes of limitations, the Court determines that all federal and state FCA violations based on false claims submitted before March 31, 1999 (other than California claims) are barred by the statute of limitations. However, the Court also concludes Foster’s claims based on false submissions to the government on or after March 31,1999 are timely.
The Court now considers whether these post-March 31, 1999 claims have been pled with sufficient particularity under the Federal Rules of Civil Procedure.
C. Rule 9(b) Pleading Requirement
The allegations of fraud in Foster’s complaint are pled on “information and belief.” BMS argues that such pleadings are improper, and urges the Court to dismiss Foster’s complaint for failing to plead his FCA claims with the particularity required by Federal Rule of Civil Procedure 9(b).
Generally, the federal rules require that a plaintiffs complaint contain a “short and plain statement of the claim showing that the pleader is entitled to relief.”
Tuchman v. DSC Communications Corporation,
Rule 9(b)’s “particularity” requirement serves several purposes: it provides notice of the nature and grounds of the plaintiffs claim, ensuring that a defendant has sufficient information to formulate a defense; it protects defendants from harm to their reputation and goodwill; it reduces the number of frivolous suits; and, it prevents plaintiffs from filing a claim and then attempting to uncover unknown wrongs through discovery.
Tuchman,
The Fifth Circuit has established that, “[a]t a minimum, Rule 9(b) requires that a plaintiff set forth the ‘who, what, when, where, and how’ of the alleged fraud.”
United States, ex rel Williams v. Bell Helicopter Textron, Inc.,
Claims brought under the FCA must fulfill the pleading requirements of Rule 9(b).
Doe v. Dow Chemical Company,
Just as the particularity requirements of Rule 9(b) are dependant on the facts of the case, they are also dependant on Rule 8.
See United States ex rel Johnson v. Shell Oil Company,
(b) Exception: Relaxed Pleading on Information and Belief
(1) Information in Defendant’s Possession
Additionally, the Fifth Circuit has developed an exception in FCA cases that permits the particularity requirements of Rule 9(b) to be relaxed in certain circumstances.
Doe v. Dow,
In this case, Foster argues that he is entitled to this relaxed pleading standard (and may plead his claims on information and belief) because “he does not have access to certain of the precise facts related to the false claims.” (Relator’s Resp. to Def.’s Mot. to Dismiss at 18). He asserts that such information is “in the exclusive possession and/or control of Defendant and/or the United States.”
11
Id.
However, Foster’s argument that this information is possessed by a party
other
than BMS is a tacit admission that this relaxed exception does not fit. The Fifth Circuit has clearly stated that the exception applies only “when the facts relating to the alleged fraud are peculiarly within
the perpetrator’s
knowledge.”
Russell v. Epic,
With respect to the claims based on false Best Price submissions, Foster states that “the detailed false claim data supporting [his] claims is also in the hands of the
With respect to the allegations based on kickback violations, Foster faces a similar problem. As BMS points out, “the details necessary to support Relator’s allegations that BMS’s conduct in paying ‘kickbacks’ to OHP resulted in the submission of false reimbursement claims by providers” are not in BMS’s possession. (Def.’s Reply at 9) Instead, those details are in the possession of the healthcare providers who submitted the claims. So, the information concerning the alleged kickback payments, prescriptions, and resulting reimbursement claims is not in BMS’s exclusive possession. The information Foster seeks is also possessed by parties like OHP, pharmacies, and the federal and state agencies responsible for administering Medicaid reimbursements.
As such, because the information related to Foster’s claims is not peculiarly in BMS’s possession, Foster is not entitled to a relaxed pleading standard on this basis.
(2) Complex Scheme / Multi-Year Period
However, some district courts in the Fifth Circuit have also relaxed Rule 9(b)’s pleading standard where the alleged fraud occurred over an extended period of time and consists of numerous acts.
See United States ex rel. Lam v. Tenet Healthcare Corp.,
The fraud alleged by Foster consists of a scheme that occurred over the course of several years and involved numerous acts. Given these circumstances, and the cases cited in the preceding paragraph, the Court will relax the Rule 9(b) pleading requirement.
However, in spite of this leniency, Foster’s complaint is still deficient because he fails to plead sufficient facts to support his allegations made on information and belief. This deficiency is described below.
(c) Foster’s Complaint
The Court now turns to the substance of Foster’s complaint, mindful that he must plead specific facts and not mere concluso-ry allegations, but accepting as true the well-pleaded factual allegations of his complaint and reasonable inferences that may be drawn from them.
Johnson v. Shell,
(1) Foster’s Federal FCA Claims Fail to Satisfy Rule 9(b)
Because any false claims made prior to March 31, 1999 are barred by the FCA’s six-year statute of limitations, the Court will only evaluate the sufficiency of the false claims alleged to have occurred on or after March 31,1999.
As stated above, Foster’s complaint is based on incidents alleged to have occurred while he was an account manager for Parke-Davis. First, Foster claims that on multiple occasions between February 1998 and January 1999, OHP representatives told him that BMS was giving rebates and other financial incentives to OHP and its officials. Secondly, Foster claims that in December 1998, BMS regional account representative Vanessa Pappion told him that BMS did not include the incentives in the Best Price amount it reported for purposes of calculating Medicaid rebates. Foster asserts that OHP Pharmacy Director Tim Hambacher repeated this claim in March 1999. The Court must accept these factual allegations as true. Even so, Foster fails to satisfy the pleading requirements set forth in Rule 9(b) because these facts are insufficient to support the allegations set forth in his complaint.
(i) Federal FCA Claims based on Kickback Violations
Foster’s first false claim allegation states that BMS gave illegal kickbacks, thereby causing false claims for payment to be submitted to the government. This
Foster claims that BMS paid unlawful rebates, discounts and other financial incentives to OHP in order to gain placement on the OHP formulary. As a result (Foster argues) OHP physicians prescribed BMS’s drugs to all of their patients. Such health care providers would then submit claims for payment to Medicaid. On this basis, Foster asserts that “[a]ll claims for payment resulting from these illegally-induced recommendations were false claims. By paying such illegal incentives, Defendant BMS caused the submission of false claims for payment in violation of federal and state False Claims Acts.” (Relator’s Compl. At 16).
This cryptic allegation appears to be an attempt to plead false claims based on the “implied certification” theory of liability.
See In re Pharmaceutical Industry Average Wholesale Price Litigation,
The theory of implied certification rests on the notion that “where the government pays funds to a party, and would not have paid those funds had it known of a violation of a law or regulation, the claim submitted for those funds contained an implied certification of compliance with the law or regulation and was fraudulent.”
United States ex rel. Barrett v. Columbia/HCA Healthcare Corp.,
The Fifth Circuit has never formally recognized the “implied certification” theory.
See United States ex rel Willard v. Humana Health Plan of Texas, Inc.,
With some degree of particularity, Foster describes various financial incentives paid by BMS to OHP and its representatives, including: retroactive rebates and cash grants to OHP’s pharmacy department; research grants, consulting and speaking fees, and the use of a private jet to Dr. Milani (the head of OHP’s Pharmaceuticals committee). Foster alleges that these kickbacks resulted in BMS’s drugs being included in the OHP formulary. From these facts, Foster then jumps to a number of unsubstantiated conclusions.
First, Foster claims that a placement on the OHP formulary caused “OHP physicians to prescribe Defendant’s drugs over its competitors’ not only to OHP patients but also to physicians’ entire patient population comprised of, among others, Medicaid subscribers.” (Relator’s Resp. to Def.’s Mot. to Dismiss at 25). However, Foster provides not one factual detail or example to support this allegation. He does not name any OHP physician who issued such prescriptions, nor any patient who received them — much less show that the patient was connected to Medicaid.
See, e.g., Barrett,
Nevertheless, from his unsupported claim about doctor’s recommendations, Foster then leaps to the conclusion that false claims resulted. He states that “[a]ll claims for payment resulting from these illegally-induced recommendations were false claims. By paying such illegal incentives, Defendant BMS caused the submission of false claims for payment in violation of federal and state False Claims Acts.” (Relator’s Resp. to Def.’s Mot. to Dismiss at 16) Despite the boldness of this assertion, Foster does not provide a single factual detail from which the Court could infer that a claim for payment was actually submitted to the government. Frankly, it is not completely clear from the face of the complaint what Foster means by a “claim for payment.” Presumably, he is referring to claims for reimbursement submitted by doctors to Medicare and/or Medicaid after prescribing BMS drugs. The only factual details Foster supplies in support of his AKS-based claims are his allegations that BMS provided kickbacks to OHP. Faced with similar facts in
Rost,
the First Circuit stated that the pleadings may “suggest
The Court concludes that even under a relaxed pleading standard, Foster has failed to set forth the factual basis for his “information and belief’ that the kickback scheme resulted in the submission of false claims.
Accord Sanderson v. HCA
—the
Healthcare Company,
(ü) Federal FCA Claims Based on False Best Price Submissions
Foster’s Best Price claims are similarly speculative. To briefly recap these claims: Foster alleges that from 1998 through 2002, BMS did not factor the financial incentives given to OHP into its Best Price reports. By omitting this information BMS would have effectively reduced the reimbursement amounts due to state Medicaid programs, and paid less in rebates than what it actually owed.
Foster’s Best Price claims are characterized as ‘reverse claims’ under the FCA, since they are based on the idea that BMS misrepresented its Best Price to the government in order to reduce its obligation to pay Medicaid rebates to the states. See 31 U.S.C. § 3729(a)(7). Under this reverse claim theory, the ‘claim for payment’ to which liability attaches is the Best Price report. This report is submitted to the government on a quarterly basis. Here, Foster alleges that BMS reported false Best Prices after the end of each quarter, from January 1998 through January 2002. The Court has already concluded that any false claims submitted prior to March 31, 1999 are barred by the FCA’s six-year statute of limitations. Therefore, the Court’s consideration is limited to the Best Price reports submitted from April 1999 through January 2002.
Here again, Foster pleads his Best Price claims on information and belief. But, even under a relaxed Rule 9(b) pleading standard, he must provide sufficient facts to support the allegations he makes on information and belief.
See Lam,
The specific factual basis given by Foster for the Best Price claims includes his knowledge of kickbacks given to OHP, but centers on two specific conversations: his December 1998 communication with Vanessa Pappion; (Relator’s Compl. at 14); and his March 1999 exchange with
To begin with, the Pappion and Ham-bacher statements were not forward-looking assertions that expressed an intent to submit false Best Price reports in the future. They were statements about what had occurred up to that time. As such, they necessarily require an inference that because BMS omitted the financial incentives from its Best Price reports in the past, they continued to do so in the future — from April 1999 through 2002. Foster “is entitled to all inferences that surface from a fair and reasonable reading of the pleadings.”
Westfall v.
Miller,
Foster’s complaint includes no factual allegations of fraud beyond the first quarter of 1999. (Relator’s Compl. at 15-16). 14 The complaint does not describe any grants, rebates, kickbacks or other financial incentives given to OHP after March 1999. Further, Hambacher’s statement in March 1999 is the last fact given to suggest that BMS may have ever inflated its Best Price. Foster provides no other facts to support his claim that BMS inflated its Best Price from that time until 2002.
Actually, other facts presented in the complaint undercut Foster’s assertions by making his allegations appear more speculative, and the inferences they require less reasonable. For example, Foster claims that he learned about BMS’s fraudulent practices by virtue of his work as an account manager for Parke-Davis. (Relator’s Resp. to Def.’s Mot. to Dismiss at 5) However, Foster left that position in September 2000; presumably cutting-off his source of information. Yet without any explanation, he alleges that BMS continued to submit false Best Price Reports for the next sixteen months. Foster offers no factual support for this allegation. The basis for his belief is completely absent from the complaint.
While Foster has identified the approximate dates upon which BMS submitted Best Price reports, his ability to do so is not based on any firsthand knowledge of the reports. The dates for submitting Best Price reports are established by statute. This fact does not undermine his position; but it does not provide any factual support for his allegations either. Knowing the approximate statutory dates, Foster alleges on information and belief that the Best Prices reported were false. However, he does not support his belief that such reports were false with any factual details. Without such details, his allegations are deficient.
Although this Court has chosen to relax the pleading requirements of Rule 9(b), the Fifth Circuit has cautioned that such a relaxed standard “must not be mistaken for license to base claims of fraud on speculation and conelusory allegations.”
Thompson,
(iii) Federal FCA Claims Based on Inflated Drug Prices for Section SU0B Entities
Finally, Foster’s FCA claim that BMS overcharged federally-qualified entities under the Section 340B drug discount program fails to satisfy Rule 9(b) for the same reason: he provides no factual basis for his allegations. As explained in Sections 1(B) and 1(C) supra, the Best Price is used to calculate the Medicaid rebate percentage; while the Medicaid rebate percentage is used to calculate Section 340B drug prices. Foster’s Section 340B claim is based solely on the theory that because BMS reported false Best Prices, it reduced its Medicaid rebate percentage, and thereby inflated the drug prices it charged to Section 340B entities. He provides no additional facts whatsoever to support his Section 340B claim. The claim depends completely on the charge that BMS reported false Best Prices. This Court has already concluded that Foster’s complaint does not provide a sufficient factual basis to support his Best Price claims. Therefore, his Section 340B claims likewise fail to satisfy, the requirements of Rule 9(b).
(2) Foster’s State FCA Claims Fail to Satisfy Rule 9(b)
In addition to his federal FCA claims, Foster alleges that BMS violated the state FCAs of Texas, Illinois, California, Florida, and Massachusetts. These state claims are likewise subject to the pleading requirements of Rule 9(b).
See, e.g., Williams v. WMX Technologies, Inc.,
Because the statutes of limitations under the Texas, Illinois, Florida and Massachusetts FCAs are as short as (or shorter than) the federal FCA, Foster’s claims under those state FCAs are exactly the same as those considered by the Court in addressing Foster’s federal FCA claims. The analysis that applied to the federal claims applies equally to the Texas, Illinois, Florida and Massachusetts claims. So, for the same reasons given above, the Court finds that Foster has failed to provide a factual basis for the Texas, Illinois, Florida and Massachusetts FCA claims
(d) Conclusion
For the foregoing reasons, the Court finds that Foster’s complaint fails to provide a sufficient factual basis for any false claims submitted on or after March 31, 1999. As such, Foster’s claims under the federal FCA (Count I), the Texas MFPL (Count II), the Illinois FCA (Count III), the Florida FCA (Count V), and the Massachusetts FCA (Count VI) will be dismissed.
Having determined that all such claims fail, the only remaining claims are those brought under the California FCA.
D. California FCA Claims
Foster’s claims under the California FCA are not identical to the federal FCA claims already analyzed by the Court. Because the statute of limitations under the California FCA is ten years, the California claims date back to January 1998, while the timely federal FCA claims analyzed above began on March 31, 1999. So, an all-inclusive analysis of Foster’s California FCA claims would require the Court to consider a set of claims different from (and in addition to) those considered above. The Court would have to analyze whether Foster has provided a sufficient factual basis for all of the false claims which he alleges BMS submitted from January 1998 through 2002, rather than just those submitted from March 31, 1999 through 2002. That analysis might well reach conclusions different from those stated above. However, the Court will not delve into such considerations. Having dismissed Foster’s federal claims, the Court declines to exercise supplemental jurisdiction over his remaining claims brought under the California FCA.
When federal law claims that serve as the basis for subject matter jurisdiction are dismissed and only state law claims remain, a district court has broad discretion to decline to exercise supplemental jurisdiction over the remaining claims.
See City of Chicago v. International Coll. of Surgeons,
A court considering whether to exercise supplemental jurisdiction over state law claims must consider the provisions of 28 U.S.C. § 1367(c) and the factors outlined by the Supreme Court in
Having considered these factors and the totality of the circumstances, the Court finds that, on the balance, the factors weigh in favor of dismissal of Foster’s claims under the California FCA. The Court declines to exercise supplemental jurisdiction over such claims.
E. Leave to Amend the Complaint
As a final matter, Foster asserts that if the Court determines that his complaint is deficient under Rule 9(b), the Court should grant him leave to amend rather than dismissing his claims. In support of this position, Foster reminds the Court of the Fifth Circuit’s view that “a plaintiffs failure to meet the specific pleading requirements [of Rule 9(b) ] should not automatically or inflexibly result in dismissal of the complaint with prejudice to re-filing.”
Hart v. Bayer Corp.,
While Foster has not filed a separate motion to amend, supported by affidavits, a brief, or a proposed amended complaint, he has expressly requested leave to amend. And, the Fifth Circuit has determined that Rule 15(a) applies where a plaintiff expressly requests leave to amend, even though his request is “not contained in a properly captioned motion paper.”
Willard,
Foster fails to set forth with particularity the grounds for the amendment and the relief sought. Instead, he makes the type of “bare request” disapproved of by the Fifth Circuit. Foster states simply that
Furthermore, the record suggests that the defects in Fosters complaint cannot be cured by granting him leave to amend. Foster has stated that he does not have access to the precise facts related to false claims allegedly submitted by BMS. (Relator’s Resp. to Def.’s Mot. to Dismiss at 18-19). When a defect in the complaint is incurable, a court may dismiss the claim without granting leave to amend.
See Hart,
In summary, Foster’s failure to provide particular grounds for an amendment, combined with the apparent futility of any such amendment, justify denying his request to amend the complaint.
IV. Conclusion
IT IS THEREFORE ORDERED that Defendant’s Motion to Dismiss Relator’s Complaint and Memorandum of Points and Authorities in Support [Clerk’s Docket No. 22] is GRANTED IN PART consistent with the foregoing discussion.
IT IS FURTHER ORDERED that Relator John David Foster’s federal FCA claims (Count I) are DISMISSED WITH PREJUDICE. 16
IT IS FURTHER ORDERED that Relator John David Foster’s claims under the Texas MFPL (Count II), the Illinois FCA (Count III), the Florida FCA (Count V), and the Massachusetts FCA (Count VI) are DISMISSED WITH PREJUDICE.
IT IS FURTHER ORDERED that Relator John David Foster’s claims under the California FCA (Count IV) are DISMISSED WITHOUT PREJUDICE.
SO ORDERED.
Notes
. 31 U.S.C. § 3729 et seq. (2008)
. The slate statutes cited by Foster are the Texas Medicaid Fraud Prevention Law, Tex. Hum. Res.Code Ann. §§ 36.001
et seq.;
the Illinois Whistleblower Reward and Protection Act, 740 Ill. Comp. Stat. 175
et seq.;
the California False Claims Act, Cal. Gov’t Code §§ 12650
et seq.;
the Florida False Claims Act, Fla. Stat. §§ 68.081
et seq.;
and the Massachusetts False Claims Law, Mass. Gen. Laws ch. 12, §§ 5
et seq.
These state FCAs are textually similar and substantively the same as the federal FCA.
See Pfingston v. Ronan Engineering Co.,
. Glueophage is an oral antihyperglycemic drug used to manage Type II diabetes. Though Foster’s complaint (and this opinion) primarily discuss Pravachol, Foster's allegations of kickbacks and false claim submissions relate to both Pravachol and Glueophage.
. The Fifth Circuit has long followed the standard of review set forth in
Conley v. Gibson,
. "Qui tam" is an abbreviation of the Latin phrase
qui tam pro domino rege quam pro se ipso in hac parte sequitur,
which translates to ‘who pursues this action on our Lord the King’s behalf as well as his own.'
United States ex rel. Rost v. Pfizer, Inc., 507
F.3d 720, 727 n. 4 (1st Cir.2007) (citing
Rockwell Int’l Corp. v. United States,
. Defendants dispute that Foster’s complaint states a false claim of any kind under Section 3729(a). The Court does not reach that question; and by this comment only intends to clarify the general nature of Foster’s claims.
. The statute of limitations under the California FCA is ten years.
See State ex rel. Hindin v. Hewlett-Packard Co.,
. The statute of limitations under the Florida FCA was amended, effective July 1, 2007, to be six years like the federal FCA. See Fla. Stat. § 68.089 (2007).
. The Complaint must be served on the state before it is unsealed. Tex. Hum. Res. § 36.012(a). This Court unsealed Foster's Complaint on June 27, 2007.
. Alternatively, if the State of Texas has not yet received the “material evidence and information,’’ then Foster failed to effect proper service (under Section 36.102(a)) before the complaint was unsealed and his claim must be dismissed.
See, e.g., United States ex rel Pilon v. Martin Marietta Corp.,
. There is a certain irony in Foster’s argument that he is hindered because the United States government is in possession of the requisite information. A fundamental principle of a
qui tam
suit is that the relator possesses information that the government does
not
have.
See, e.g., Russell v. Epic Healthcare,
. Although the Russell Court referred to the "Healthcare Financing Administration,” the reference is to the same agency cited by Foster. On July 21, 2001, the Healthcare Financing Administration was renamed the "Centers for Medicare and Medicaid Services.” See http://www.cms.hhs.gov.
. Foster describes the influence of the kickbacks on prescription patterns as a “spillover effect,” which impacted federal programs and federal dollars. Foster points out that such spillover “has long been recognized by federal courts and legal scholars as having a significant effect on domestic commerce and federal product pricing indices, particularly in antitrust litigation.” (Relator’s Resp. to Def's Mot. to Dismiss at 25). Accepting that statement at face value, it is still unclear how such a “spillover effect" is relevant in false claims litigation. Plaintiff has failed to explain — and this Court can find no case that explains— how spillover amounts to a false claim that would be actionable in this FCA suit. As previously stated, "[e]vidence of an actual false claim is the
sine qua non
of a False Claims Act violation.”
Karvelas,
. Foster does allege that he met with OHP’s Dr. Richard Milani in April 1999. However, he claims that during that meeting they only discussed financial grants that BMS had “already provided.” (Relator's Compl. at 15-16).
. Under Section 1367(c) a district court may decline to exercise supplemental jurisdiction if:
(1) the claim raises a novel or complex issue of state law,
(2) the claim substantially predominates over the claim or claims over which the court has original jurisdiction,
(3) the district court has dismissed all claims over which it has original jurisdiction, or
(4) in exceptional circumstances, there are other compelling reasons for declining jurisdiction.
28 U.S.C. § 1367(c).
. Because the government has not intervened, the Court does not dismiss this action with prejudice as to the United States.
See Williams v. Bell Helicopter,
