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United States of America v. United Health Group, Inc. et al

OPPOSITION to NOTICE OF MOTION AND MOTION to Dismiss United States First Amended Complaint-In-Partial-Intervention; Memorandum of Points and Authorities in Support Thereof 182

21 Cited authorities

  1. Matrixx Initiatives, Inc. v. Siracusano

    563 U.S. 2011 (2011)   Cited 1,338 times   57 Legal Analyses
    Holding that plaintiffs had adequately pled a Rule 10b–5 claim—where defendant had disputed the sufficiency of the allegations with respect to the elements of scienter and materiality—by alleging that defendant had forestalled a stock price drop by making affirmative statements confirming the market's impression that defendant's leading product was safe, despite defendant's awareness of evidence suggesting a significant risk that the nasal spray led to loss of sense of smell; when the risk was finally (belatedly) disclosed, the stock price plummeted

  2. Universal Health Servs., Inc. v. United States

    579 U.S. 176 (2016)   Cited 864 times   184 Legal Analyses
    Holding that " misrepresentation" about a claim's compliance with the law "must be material to the Government's payment decision in order to be actionable under the [FCA]," and that the Government's payment of "a particular claim in full despite its actual knowledge that certain requirements were violated . . . is very strong evidence that those requirements are not material"

  3. Kungys v. United States

    485 U.S. 759 (1988)   Cited 694 times   2 Legal Analyses
    Holding that the government must meet its burden with "clear, unequivocal, and convincing" evidence

  4. Wyler Summit v. Turner Broadcasting Sys

    135 F.3d 658 (9th Cir. 1998)   Cited 1,208 times
    Denying motion to dismiss contract claim

  5. Dennis v. United States

    384 U.S. 855 (1966)   Cited 936 times   1 Legal Analyses
    Holding that the true nature of the crime was the entire conspiracy to falsely obtain benefits from the N.L.R.B., in violation of § 371, and not merely the false statements made in furtherance of the conspiracy

  6. United States v. United Healthcare Ins. Co.

    848 F.3d 1161 (9th Cir. 2016)   Cited 334 times   1 Legal Analyses
    Holding Rule 9(b) requires allegations specifying "what is false or misleading about a statement, and why it is false"

  7. Bryson v. United States

    396 U.S. 64 (1969)   Cited 233 times   2 Legal Analyses
    Holding citizen does not have privilege to falsely answer a question that the government should not have asked

  8. Cedars-Sinai Med. Ctr. v. Shalala

    125 F.3d 765 (9th Cir. 1997)   Cited 217 times
    Holding that § 2401 is not jurisdictional and therefore subject to waiver

  9. United States ex rel. Campie v. Gilead Scis., Inc.

    862 F.3d 890 (9th Cir. 2017)   Cited 119 times   27 Legal Analyses
    Holding that retaliation complaint by a "Senior Director of Global Quality Assurance" adequately pleaded notice because, inter alia , the employer knew the employee had "conversations outside of his chain of command regarding his concerns"

  10. United States ex rel. Escobar v. Universal Health Servs., Inc.

    842 F.3d 103 (1st Cir. 2016)   Cited 83 times   6 Legal Analyses
    Holding that actual knowledge was not established where state regulators had notice of complaints of noncompliance but "did not conclusively discover the extent of the violations until.... well after the commencement of the litigation"

  11. Section 3729 - False claims

    31 U.S.C. § 3729   Cited 6,735 times   628 Legal Analyses
    Holding liable "any person" who knowingly causes false claims to be presented

  12. Section 1395w-22 - Benefits and beneficiary protections

    42 U.S.C. § 1395w-22   Cited 182 times   13 Legal Analyses
    Stating that an MAO may charge a primary plan when a payment "is made secondary pursuant to section 1395y(b)"

  13. Section 1395w-23 - Payments to Medicare+Choice organizations

    42 U.S.C. § 1395w-23   Cited 68 times   12 Legal Analyses

    (a) Payments to organizations (1) Monthly payments (A) In general Under a contract under section 1395w-27 of this title and subject to subsections (e), (g), (i), and (l) and section 1395w-28(e)(4) of this title, the Secretary shall make monthly payments under this section in advance to each Medicare+Choice organization, with respect to coverage of an individual under this part in a Medicare+Choice payment area for a month, in an amount determined as follows: (i) Payment before 2006 For years before

  14. Section 422.504 - Contract provisions

    42 C.F.R. § 422.504   Cited 35 times   6 Legal Analyses
    Referencing data reported under 42 C.F.R. § 422.310