§Why CasetextPricing

United States of America et al v. Kpc Healthcare Inc et al

NOTICE OF MOTION AND MOTION to Dismiss First Amended Complaint

23 Cited authorities

  1. Ashcroft v. Iqbal

    556 U.S. 662 (2009)   Cited 254,951 times   280 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. Universal Health Servs., Inc. v. United States

    579 U.S. 176 (2016)   Cited 874 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"

  3. Cafasso v. General Dynamics C4 Systems

    637 F.3d 1047 (9th Cir. 2011)   Cited 2,523 times   15 Legal Analyses
    Holding a complaint failed to satisfy Rule 9(b) where the allegations were lacking in detail

  4. United States ex rel. Lee v. Corinthian Colls.

    655 F.3d 984 (9th Cir. 2011)   Cited 1,510 times   1 Legal Analyses
    Holding that this Court "can affirm a 12(b) dismissal 'on any ground supported by the record, even if the district court did not rely on the ground.'" (quoting Livid Holdings, Ltd. v. Salomon Smith Barney, Inc., 416 F.3d 940, 950 (9th Cir. 2005))

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

    616 F.3d 993 (9th Cir. 2010)   Cited 519 times   13 Legal Analyses
    Holding that qui tam plaintiffs must allege "reliable indicia that lead to a strong inference that claims were actually submitted"

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

    848 F.3d 1161 (9th Cir. 2016)   Cited 340 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. Gonzalez v. Planned Parenthood of L.A.

    759 F.3d 1112 (9th Cir. 2014)   Cited 186 times   3 Legal Analyses
    Affirming denial of leave to amend where plaintiff's allegations were "merely possible rather than plausible," and where plaintiff had failed to "overcome the plausible and obvious explanation that [the defendant] did not knowingly submit false claims"

  8. United States ex rel. Durcholz v. FKW Inc.

    189 F.3d 542 (7th Cir. 1999)   Cited 138 times   2 Legal Analyses
    Holding that innocent mistakes or negligence are not actionable under the FCA

  9. U.S. v. Murphy

    937 F.2d 1032 (6th Cir. 1991)   Cited 96 times
    Reversing summary judgment for the government on a False Claims Act conspiracy claim

  10. United States ex rel. Modglin v. Djo Global Inc.

    114 F. Supp. 3d 993 (C.D. Cal. 2015)   Cited 33 times   2 Legal Analyses
    Dismissing FCA claim, reasoning in part that "[the regulation] does not concern reimbursement, and contains its own internal sanction—i.e., loss of billing privileges."

  11. Rule 8 - General Rules of Pleading

    Fed. R. Civ. P. 8   Cited 157,459 times   196 Legal Analyses
    Holding that "[e]very defense to a claim for relief in any pleading must be asserted in the responsive pleading. . . ."

  12. Section 3729 - False claims

    31 U.S.C. § 3729   Cited 6,766 times   630 Legal Analyses
    Holding liable "any person" who knowingly causes false claims to be presented

  13. Section 3730 - Civil actions for false claims

    31 U.S.C. § 3730   Cited 5,400 times   430 Legal Analyses
    Granting the government primary responsibility for conducting suit

  14. Section 1395x - Definitions

    42 U.S.C. § 1395x   Cited 1,162 times   40 Legal Analyses
    Stating that the regulations "may provide for using different methods in different circumstances"

  15. Section 1395d - Scope of benefits

    42 U.S.C. § 1395d   Cited 230 times   4 Legal Analyses
    Establishing that hospice providers may collect reimbursement for an unlimited number of recertification periods

  16. Section 1395w-21 - Eligibility, election, and enrollment

    42 U.S.C. § 1395w-21   Cited 187 times   2 Legal Analyses
    Listing 42 U.S.C. §§ 1395w-22, 1395w-23, (g), (h), (m), 1395ww(d), (h)(D)

  17. Section 1395k - Scope of benefits; definitions

    42 U.S.C. § 1395k   Cited 158 times
    Providing that a beneficiary is "entitle[d] to have payment made to him or on his behalf (subject to the provisions of [Medicare Part B]) for medical and other health services"

  18. Section 1395l - Payment of benefits

    42 U.S.C. § 1395l   Cited 113 times   39 Legal Analyses
    Providing separate formula for calculating "amount of payment under this subsection for a specified covered outpatient drug"

  19. Section 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments

    42 C.F.R. § 422.308   Cited 10 times   1 Legal Analyses

    CMS performs the following calculations and adjustments to determine rates and payments: (a)National per capita growth percentage. (1) The national per capita growth percentage for a year, applied under § 422.306 , is CMS' estimate of the rate of growth in per capita expenditures under this title for an individual entitled to benefits under Part A and enrolled under Part B. CMS may make separate estimates for aged enrollees, disabled enrollees, and enrollees who have ESRD. (2) The amount calculated

  20. Section 401.305 - Requirements for reporting and returning of overpayments

    42 C.F.R. § 401.305   Cited 8 times   30 Legal Analyses

    (a)General. (1) A person that has received an overpayment must report and return the overpayment in the form and manner set forth in this section. (2) A person has identified an overpayment when the person has, or should have through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment. A person should have determined that the person received an overpayment and quantified the amount of the overpayment if the person