United States, ex rel. Andrew Gelbman v. City of New York, et al.

When a Petitioner invokes the False Claims Act (FCA), 31 U.S.C. § 3729 et seq. (Pet. App. 119a156a), to assert that the Federal Government (“the Government”) has been defrauded, it is well-settled that a plaintiff-relator must plausibly allege that an untrue statement or claim was made to the Government to gain a benefit under a federal benefits program, e.g. Medicaid program reimbursements. See § 3729(b)(2)(A) (Pet. App. 121a); Universal Health Servs., Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989, 1996 (2016). The Second Circuit determined that Petitioner failed to allege sufficient specificity in its Second Amended Complaint and dismissed the same pursuant to FRCP 9(b) and 12(b). The first question presented is: whether the pleading standard should be different for False Claims Act claims against public sector Medicaid providers than it is for such claims against private sector Medicaid providers. The second question presented is: whether the Second Circuit erred in drawing all inferences in favor of Respondents rather than drawing all reasonable inferences in favor of Petitioner. The third question presented is: whether the scheme of fraud by The City of New York against the Government as set forth in Petitioner’s Second Amended Complaint ((Pet. App. 1a-52a) “SAC”) represents a plausible claim sufficient to avoid dis-