Second Circuit Eases Pleading Standards for Reverse False Claims Act Cases
The U.S. Court of Appeals for the Second Circuit ruled that False Claims Act relators can satisfy Federal Rule of Civil Procedure 9(b) pleading requirements without identifying every false claim in an alleged fraudulent scheme. The decision in United States ex rel. Gallian v. AmerisourceBergen also left unresolved whether Rule 9(b)'s heightened pleading standards apply at all to reverse False Claims Act claims, which involve defendants who improperly retain government overpayments rather than submitting false claims for payment. The ruling applies to cases filed in the Second Circuit (Connecticut, New York, Vermont) and may influence how FCA cases proceed in other jurisdictions.
The decision lowers the evidentiary bar for whistleblowers to survive dismissal in Medicaid fraud cases involving undisclosed overpayments or kickbacks, potentially increasing litigation exposure for health plans, providers, and pharmaceutical companies operating in the Second Circuit.
Pharmacy · Managed Care
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