Molina Healthcare of Illinois, Inc., et al. v. Thomas Prose

This petition presents the same question as Johnson v. Bethany Hospice & Palliative Care LLC, No. 21-462, and United States ex rel. Owsley v. Fazzi Assocs., Inc., No. 21-936, regarding Federal Rule of Civil Procedure 9(b)’s application to False Claims Act cases. Circuit courts are divided over whether FCA plaintiffs must plead the element of a false claim with particularity, or whether the existence of a false claim can simply be inferred, as the Seventh Circuit held. This petition also raises a second conflict. Universal Health Services, Inc. v. United States ex rel. Escobar held that a claim can be “false or fraudulent” if (1) the claim makes representations about the goods or services provided; and (2) the defendant’s failure to disclose material statutory, regulatory, or contractual noncompliance makes those representations misleading half-truths. 579 U.S. 176, 187, 190 (2016). Circuit courts disagree over whether a claim that makes no representations about the goods or services at issue can be deemed “false or fraudulent” via an “implied” certification of compliance with underlying conditions, with the Seventh Circuit concluding that it can. The questions presented are:

1. Whether Rule 9(b) requires plaintiffs in False Claims Act cases to plead details of the alleged false claims.

2. Whether a request for payment that makes no specific representations about the goods or services provided can be actionable under an implied false certification theory.