§Why CasetextPricing

Jackson et al v. Depaul Health System et al

MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM

56 Cited authorities

  1. Ashcroft v. Iqbal

    556 U.S. 662 (2009)   Cited 254,433 times   279 Legal Analyses
    Holding that a claim is plausible where a plaintiff's allegations enable the court to draw a "reasonable inference" the defendant is liable

  2. Bell Atl. Corp. v. Twombly

    550 U.S. 544 (2007)   Cited 268,213 times   366 Legal Analyses
    Holding that a complaint's allegations should "contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face' "

  3. Fowler v. UPMC Shadyside

    578 F.3d 203 (3d Cir. 2009)   Cited 14,140 times   4 Legal Analyses
    Holding that the district court did not abuse its discretion "in denying a motion for a class action determination which was untimely under the local rule"

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

    579 U.S. 176 (2016)   Cited 870 times   185 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"

  5. Frederico v. Home Depot

    507 F.3d 188 (3d Cir. 2007)   Cited 2,226 times   8 Legal Analyses
    Holding a dismissal order "without prejudice" was a final order because the plaintiff elected to stand on her original complaint rather than amend or refile it

  6. In re Rockefeller Center Properties, Inc.

    311 F.3d 198 (3d Cir. 2002)   Cited 1,347 times
    Holding that a plaintiff must set forth the "who, what, when, where, and how" of the alleged fraud

  7. U.S. ex Rel. Clausen v. Laboratory Corp.

    290 F.3d 1301 (11th Cir. 2002)   Cited 821 times   14 Legal Analyses
    Holding Rule 9(b) applies to False Claims Act claims

  8. Ebeid ex Rel. U.S. v. Lungwitz

    616 F.3d 993 (9th Cir. 2010)   Cited 518 times   13 Legal Analyses
    Holding that qui tam plaintiffs must allege "reliable indicia that lead to a strong inference that claims were actually submitted"

  9. U.S. ex Rel. Wilkins v. United Health Group

    No. 10-2747 (3d Cir. Jun. 30, 2011)   Cited 370 times   5 Legal Analyses
    Holding that plaintiffs "need not allege a relationship between the alleged [anti-kickback] violations and the claims ... submitted to the Government"

  10. Mikes v. Straus

    274 F.3d 687 (2d Cir. 2001)   Cited 434 times   27 Legal Analyses
    Holding that false certification theory applies when "governing federal rules . . . are a precondition to payment"

  11. Rule 12 - Defenses and Objections: When and How Presented; Motion for Judgment on the Pleadings; Consolidating Motions; Waiving Defenses; Pretrial Hearing

    Fed. R. Civ. P. 12   Cited 347,669 times   925 Legal Analyses
    Granting the court discretion to exclude matters outside the pleadings presented to the court in defense of a motion to dismiss

  12. Rule 8 - General Rules of Pleading

    Fed. R. Civ. P. 8   Cited 157,162 times   196 Legal Analyses
    Holding that "[e]very defense to a claim for relief in any pleading must be asserted in the responsive pleading. . . ."

  13. Rule 9 - Pleading Special Matters

    Fed. R. Civ. P. 9   Cited 39,048 times   320 Legal Analyses
    Permitting "[m]alice, intent, knowledge, and other conditions of a person's mind [to] be alleged generally"

  14. Section 3729 - False claims

    31 U.S.C. § 3729   Cited 6,754 times   628 Legal Analyses
    Holding liable "any person" who knowingly causes false claims to be presented

  15. Section 3730 - Civil actions for false claims

    31 U.S.C. § 3730   Cited 5,390 times   430 Legal Analyses
    Granting the government primary responsibility for conducting suit

  16. Section 1396 - Medicaid and CHIP Payment and Access Commission

    42 U.S.C. § 1396   Cited 3,148 times   9 Legal Analyses
    Distinguishing explicitly between state- and federally-funded patient populations

  17. Section 1395c - Description of program

    42 U.S.C. § 1395c   Cited 499 times
    Referring to 42 U.S.C. § 402, 414

  18. Section 483.1 - Basis and scope

    42 C.F.R. § 483.1   Cited 69 times
    Explaining that the regulations in the relevant subpart of the Code of Federal Regulations are based on the "Act"

  19. Section 483.75 - Quality assurance and performance improvement

    42 C.F.R. § 483.75   Cited 66 times   13 Legal Analyses
    Governing facility administration

  20. Section 483.30 - Physician services

    42 C.F.R. § 483.30   Cited 32 times   12 Legal Analyses
    Nursing services

  21. Section 413.335 - Basis of payment

    42 C.F.R. § 413.335   Cited 8 times
    Providing that "[u]nder the prospective payment system, [skilled nursing facilities] receive a per diem payment of a predetermined rate for inpatient services furnished to Medicare beneficiaries"

  22. Section 211.12 - Nursing services

    28 Pa. Code § 211.12   Cited 6 times   1 Legal Analyses

    (a) [Reserved]. (b) There shall be a full-time director of nursing services who shall be a qualified licensed registered nurse. (c) The director of nursing services shall have, in writing, administrative authority, responsibility and accountability for the functions and activities of the nursing services personnel and shall serve only one facility in this capacity. (d) The director of nursing services shall be responsible for: (1) Standards of accepted nursing practice. (2) Nursing policy and procedure

  23. Section 1187.96 - Price- and rate-setting computations

    55 Pa. Code § 1187.96   Cited 5 times
    Relating to price- and rate-setting computations

  24. Section 1187.95 - General principles for rate and price setting

    55 Pa. Code § 1187.95   Cited 2 times

    (a) Prices will be set prospectively on an annual basis during the second quarter of each calendar year and be in effect for the subsequent July 1 through June 30 period. (1) Peer group prices will be established for resident care costs, other resident related costs and administrative costs. (2) If a peer group has an even number of nursing facilities, the median peer group price determined will be the arithmetic mean of the costs of the two nursing facilities holding the middle position in the peer

  25. Section 413.337 - Methodology for calculating the prospective payment rates

    42 C.F.R. § 413.337

    (a)Data used. (1) To calculate the prospective payment rates, CMS uses- (i) Medicare data on allowable costs from freestanding and hospital-based SNFs for cost reporting periods beginning in fiscal year 1995. SNFs that received "new provider" exemptions under § 413.30(e)(2) are excluded from the data base used to compute the Federal payment rates. In addition, allowable costs related to exceptions payments under § 413.30(f) are excluded from the data base used to compute the Federal payment rates;