Lead Opinion
Gaudineer & Comito, L.L.P., a qui tam relator, brought this action under the False Claims Act against Iowa, the Iowa Department of Human Services (DHS), Gary Gesaman, an employee of DHS and the director of a state program which receives Medicaid funding, and other individuals and organizations which implement the state program. After the Supreme Court issued its decision in Vermont Agency of Natural Res. v. United States ex rel. Stevens,
Iowa received federal funding through DHS for a Medicaid program called the Home and Community Based Services Waiver. The waiver program allowed an individual with a developmental disability requiring intermediate level care to receive Medicaid funding for home and community based services rather than obtaining them in an institution. DHS promulgated and published eligibility rules for each year the waiver program was in operation. The Iowa rules defined “mental retardation” and “intermediate care facility.” See IOWA ADMIN. CODE 441-83.60. The Iowa regulations were consistent with federal law, and the United States Department of Health and Human Services and Iowa entered into a three year funding agreement for the waiver program in 1992 and a five year agreement in 1995. The program was administered by Gary Gesaman.
Relator sued Iowa, DHS, Gary Gesaman in his official capacity, and other parties for violating the False Claims Act (FCA), 31 U.S.C. § 3729. The FCA allows a private party, like the relator in this case, to bring a qui tam action on behalf of the United States alleging submission of a fraudulent claim to the government. A relator may recover damages and attorneys fees if it is successful, but it is required to deliver a copy of its complaint to the United States which has the right to intervene if it wants to pursue the claim. The United States has declined to intervene in this case.
The allegations in the complaint were based on information acquired by Carlton G. Salmons, one of the attorneys in relator law firm, while he was representing Keokuk County, Iowa in a state civil proceeding in which a key issue was whether an individual was mentally retarded. The federal district court abstained from hear
In the original complaint in this case relator sued the state, DHS, and Gesaman in his official capacity, alleging that they had defrauded the United States and inappropriately spent Medicaid funds. Relator alleged that DHS and Gesaman had disregarded published rules and that “Iowa, DHS, and Gary Gesaman ha[d] operated the [waiver] program ... allowing eligibility to those who were not mentally retarded.” In respect to its claims against Gesa-man in his official capacity, it alleged that contrary to DHS regulations, “[he] decided that between March, 1992 and August 1993 persons would be eligible [for the waiver program] ... with IQs of 78 or less,” and after August 1993 with IQ’s of 75 or less. Relator claimed that Gesaman, acting on behalf of the state and DHS, allowed person “with IQs of between 70 and 78 [to participate] knowing there would be an exponential increase in the numbers of persons eligible.” Relator asserted that “Iowa, DHS or Gary Gesaman [did not] disclose or inform the United States Department of Health and Human Services” about this aspect of the program. Relator also claimed that the individual in the Keokuk County case should not have been eligible for the program but had received federal funding. Relator sought triple damages, a civil penalty of up to $10,000 for each violation, costs, and attorney fees.
The defendants filed motions to dismiss on the basis that relator’s action was not authorized by the FCA, that it was barred by the Eleventh Amendment, and that Salmons was not the original source of the information. The district court denied the motions, and discovery was initiated. Then the Supreme Court issued its decision in Stevens,
Relator continued to maintain that it could sue Gesaman in his official capacity even after Stevens and also submitted a proposed amended complaint in support of its motion to amend. The proposed pleading, alleging a claim against Gesaman in his individual capacity, was almost identical to the original allegations against the state, DHS, and Gesaman in his official capacity. Relator merely eliminated Iowa and DHS from the allegations that published rules had been disregarded and that the waiver program had allowed “eligibility to those who were not mentally retarded” and now alleged them only against Gesa-man. Relator again alleged that “Gesa-man decided that between March, 1992 and August 1993 persons would be eligible [for the waiver program] ... with IQs of 78 or less,” and after August 1993 with IQ’s of 75 or less and that Gesaman operated the program knowing there would be an increase in eligible persons. Relator now left out its earlier allegation that Ge-saman was acting “for the Defendants State and DHS.” The allegations in the proposed complaint were directed against Gesaman alone, but no new facts were alleged about his role and responsibilities as program administrator or how he may have been acting in his individual capacity.
The district court dismissed the original complaint after concluding that the remaining claim against Gesaman in his official capacity was really against the state and barred by Stevens. It also denied relator’s motion to amend, reasoning that the proposed amendment would be futile since Gesaman had been implementing a
Relator argues on appeal that the district court erred in denying it leave to amend because Gesaman is a person amenable to suit under the FCA and the Eleventh Amendment does not bar its claims for money damages against him in either his official or individual capacity. Gesa-man responds that he did not act outside his official capacity, that he is not a person under the FCA because the state is the real party in interest, and that the claims are in any event barred by the Eleventh Amendment.
Although relator contended in its brief that Gesaman was a person under the FCA when he was acting in his official capacity,
Permission to file a first amended complaint “shall be freely given when justice so requires,” Fed.R.Civ.P. 15(a), but denial of leave to amend may be justified by “undue delay, bad faith on the part of the moving party, futility of the amendment or unfair prejudice to the opposing party.” Sanders v. Clemco Indus.,
The FCA, 31 U.S.C. § 3729, subjects to liability “[a]ny person” who “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.” Although “person” has been defined by Congress to include “individuals,” 1 U.S.C. § 1, the term does not include states or state agencies. See Stevens,
Relator argues that Gesaman is a person when sued in his individual capacity for money damages under the FCA and claims that Gesaman acted in his individual capacity in extending the eligibility requirements and that the state is not the real party in interest. It also argues that whether an official is a person under the FCA should be construed the same as “person” under 42 U.S.C. § 1983. Gesaman responds that the state is the real party in interest because he did not act in his individual capacity, the Iowa indemnification statute would require that any judgement be paid with state funds, the complex DHS administrative process impacts critical aspects of state sovereignty,
In determining whether a state official may be liable for money damages in his individual capacity, courts should not rely wholly on “the elementary mechanics of captions and pleading.” Idaho v. Coeur d’Alene Tribe of Idaho,
When relator’s original claims were blocked by the Stevens decision, relator attempted to add a claim against Gesaman in his individual capacity for the same acts it had previously alleged he was performing in his official capacity. Relator added no new or different factual allegations in its amended complaint, but simply reworded its complaint to remove Iowa and DHS as defendants and to eliminate statements that Gesaman was acting “for the Defendant State and DHS.” Relator has not alleged what Gesaman’s specific duties or powers were as administrator of the program or how he acted outside those duties by issuing eligibility standards which allegedly conflicted with state regulations.
Without any allegations about the extent and nature of Gesaman’s duties, the mere assertion that he issued standards that conflicted with state law does not allege actions outside his official duties as administrator of the waiver program. Relator also has not provided any specifics of the agreements between the United States and Iowa or how Gesaman’s actions may have been in violation of those agreements and federal law. Under these circumstances, the district court did not err in denying the motion for leave to amend to add a new claim against Gesaman in his individual capacity.
Since the district court did not err in dismissing the complaint or in denying the motion to amend, we affirm the judgment.
Notes
. The Honorable Charles R. Wolle, United States District Judge for the Southern District of Iowa.
. Relator had argued in its brief that United States ex rel. Rodgers v. Arkansas,
. In light of this conclusion, we need not consider whether a state official sued in his individual capacity is a person under the FCA or whether the claims against Gesaman are barred by the Eleventh Amendment. We also need not reach the issue of whether the term "person” under the FCA should be construed as under § 1983, a position advanced by relator without citation to any authority.
Dissenting Opinion
dissenting.
I respectfully dissent. The court’s opinion today overlooks Hafer v. Melo,
Here, the law firm as relator brought a qui tarn action under the False Claims Act, 31 U.S.C. §§ 3729-33 (1994), on March 28, 1997. The complaint named the State of Iowa, the Iowa Department of Human Services, and numerous employees, including Gary Gesaman, as defendants. The original complaint did not specify the capacity in which Gesaman was being sued. On May 22, 2000, the Supreme Court decided Vermont Agency of Natural Resources v.
The district court interpreted Stevens to mean that Gesaman, the state official who implemented the state policy on behalf of the Department of Human Services, was not subject to liability in either his individual or official capacity. It stated that the alleged conduct for which Gesaman was named as a defendant wás part of his duties as a state employee; thus, in performing the alleged acts, he was the State of Iowa personified, and so not subject to suit. In my view the district court erred and should have exercised its discretion to permit the filing of the amended complaint.
The district court, and the court today, fail to take into consideration the teaching of the Supreme Court in Hafer, a 42 U.S.C. § 1983 case against state officers in their individual capacities that was based on actions the officers had taken in the course of their official duties. A prior decision had determined that “neither a state nor its officials acting in their official capacities are ‘persons’ under § 1983.” Will v. Michigan Dep’t of State Police,
Like the Court in Hafer, we confront a statute that excludes states and state agencies from its definition of “persons” that can be sued, Stevens,
Only after we have concluded that the False Claims Act permits state officials to be sued in their individual capacities do we ask whether the state is nevertheless the real party in interest and whether the suit is thus barred by the Eleventh Amendment. See Luder,
In addressing the Eleventh Amendment question presented here, it is important to recognize that “[a]s a general rule, suits seeking damages from state officials in their individual capacities are not barred by the Eleventh Amendment.” Cornforth v. Univ. of Okla. Bd. of Regents,
Finally, the court today quotes Bly-Magee v. California,
I would reverse the district court and allow amendment of the complaint to include claims against Gesaman in his individual capacity.
. See 31 U.S.C. § 3729(a) (1994) ("any person” who knowingly presents a false or fraudulent claim to the United States for payment or approval is liable for damages).
. The district court also based its decision on the belief that this court, in light of Stevens, would overrule United States ex rel. Rodgers v. Arkansas,
.Justice Thomas took no part in the consideration or decision.
