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Date: 01-31-2018

Case Style:

Philip Marsteller and Robert Swisher v. Lynn Tilton, Patriarch Partners, LLC, MD Helicopters, Inc., Norbert Vergez

Northern District of Alabama Federal Courthouse - Birmingham, Alabama

Case Number: 16-11997

Judge: Ripple

Court: United States Court of Appeals for the Eleventh Circuit on appeal from the Northern District of Alabama (Jefferson County)

Plaintiff's Attorney: Phil Benson and Gerald Robinson for Philip Marsteller and Robert Swisher

Joyce White Vance and Mary Lester Marshall for the United States of America

Defendant's Attorney: Anthony A Joseph, Christopher N. Manning, Edward C. Reddington, Kristin A. Shapiro, Ralph Harrison Smith, III and Alexis A. Lien for MD Helicopters Inc, Patriarch Partners, LLC and Lynn Tilton

Lee D. Stein for Norbert Vergez

Description: Relators Philip Marsteller and Robert Swisher brought this action against
their former employer, MD Helicopters (“MD”), and codefendants Patriarch
Partners (“Patriarch”), Lynn Tilton, and Colonel Norbert Vergez, under the qui tam
provision of the False Claims Act (“FCA” or “Act”), 31 U.S.C. §§ 3729–30.1 The
allegations of the complaint concern a series of contracts between the United States
Army (“the Army”) and MD for the purchase and support of military helicopters.
The complaint alleges that the defendants misled the Government by providing
material false or incomplete information at two points in the transactional
relationship, MD’s pre-contract representations to the Government to enter the
contracts and MD’s submission of claims for payment. The complaint also
describes other improprieties between Col. Vergez, then a representative of the
Army, and the remaining defendants. These alleged improprieties included gifts
and an offer of prospective employment.
In the district court, the defendants moved under Federal Rules of Civil
Procedure 12(b)(6) and 9(b) for dismissal for failure to state a claim. They asserted
* Honorable Kenneth F. Ripple, United States Circuit Judge for the Seventh Circuit,
sitting by designation.
1 The complaint also alleged a conspiracy count, which was the only count to name
Col. Vergez.
Case: 16-11997 Date Filed: 01/26/2018 Page: 2 of 29
that the complaint failed the specificity requirements applicable to allegations of
fraud and that, in any event, the claims did not adequately state a case for liability.
The district court granted the motion. It concluded that the complaint failed to
establish liability under the implied certification theory, because the relators had
not alleged adequately that a defendant had violated an express condition of
payment or a material contractual requirement. The district court also concluded
that the relators did not plead a fraud in the inducement theory, but that, if they
had, it would have failed for the same reasons as the implied certification theory.
The relators have appealed. During the pendency of this appeal, the Supreme
Court has examined the implied certification theory in Universal Health Services,
Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016). We conclude that the
district court must revisit whether the relators alleged facts sufficient to support a
theory of implied certification as articulated in Escobar. We also conclude that the
complaint did plead fraud in the inducement, and we therefore remand so that the
district court can reexamine the allegations relating to that theory.
Accordingly, we vacate the judgment of the district court and remand for
further proceedings consistent with this opinion.
Case: 16-11997 Date Filed: 01/26/2018 Page: 3 of 29
The allegations of the complaint concern a series of specific contracts
between MD, an Arizona corporation that manufacturers high-performance
helicopters, and the Army. The relators, Mr. Marsteller and Mr. Swisher, are the
former Director of Sales and Marketing and the former Director of Military
Business Development, respectively, for MD. Both are also Army veterans;
indeed, Mr. Swisher remains a Major in the Army Individual Ready Reserve. At all
times relevant to this action, Ms. Tilton has been CEO of MD and of Patriarch.
Patriarch, which was founded and is wholly owned by Ms. Tilton, is a debt and
equity investment and management company and performs services for MD.
From 2010 to 2012, Col. Vergez was a project manager at the Army’s Non-
Standard Rotary Wing Aircraft Office (“NSRWA”) in Huntsville, Alabama.
NSRWA is responsible for the procurement and support of non-standard rotorcraft,
including procurement for the foreign military sales program (“FMS”) of the
Department of Defense. In his role at NSRWA, Col. Vergez was personally and
substantially involved in issuing, selecting, negotiating, pricing, and awarding
FMS contracts.
Case: 16-11997 Date Filed: 01/26/2018 Page: 4 of 29
The core of the complaint addresses five contracts between MD and the
Army in 2011 and 2012. Under these agreements MD provided: (1) six helicopters
to the Afghan Air Force, (2) logistical support to the Afghan Air Force, (3) three
helicopters to the El Salvador Air Force, (4) two helicopters to the Government of
Costa Rica, and (5) twelve helicopters to the Saudi Arabian National Guard. The
forty-five-page complaint describes the interactions between MD and NSRWA on
each of these bids and contracts. In describing several of the bid processes, the
complaint alleges that the Army requested pricing data, presumably to establish the
commercial reasonableness of the price proposed in MD’s bid. The complaint
alleges that MD cherry-picked the highest priced prior sales and omitted
lower-dollar sales. With respect to one such contract, for example, the complaint
asserts that, in response to the Army’s request for a sales history,
MD only provided the Army information regarding the October 11,
2011 sale of an MD 500E to the Columbus, Ohio Police Department
for the base price of $1,802,282, but did not disclose any other prior
sales, including the May 20, 2011 sale of a new MD 500E helicopter
to Fuchs Helikopter for the base price of $1,550,000. The Army relied
on MD’s incomplete disclosure and was deprived of its ability to
effectively negotiate a reasonable and lower price which caused the
agreed base price for each aircraft to be higher than it would have
been if MD had fully complied with the Army’s request for pricing
2 R.57 at 18–19, ¶ 33.
Case: 16-11997 Date Filed: 01/26/2018 Page: 5 of 29
With respect to another contract for helicopters for the Saudi Arabian National
Guard, the complaint alleges that MD’s Chief Operations Officer sent a draft bid to
Ms. Tilton that included a price of $2,178,000 and noted that the base price for the
aircraft was $2,150,000.3 In replying to the email, Ms. Tilton asked, “Why is this
not Army pricing?”4 The COO then recommended raising the bid to $2,300,000,
and Ms. Tilton immediately approved it. Mr. Marsteller, one of the relators in this
action, alerted Ben Weiser, an executive vice president at MD, that he believed that
the pricing was “criminal.”5 Weiser then contacted Ms. Tilton and asked her to
“reconsider” the pricing, given that it was $150,000 more than the commercial list
price that MD had published two-and-a-half months earlier.6 Ms. Tilton declined to
lower the price, explaining that her decision was “not about the money but about
consistency with the Army.”7
The complaint also contains allegations about Col. Vergez’s relationship
with MD and his dealings with Ms. Tilton. According to the allegations, although
he previously had met other MD employees, Col. Vergez first met Ms. Tilton at an
3 The complaint alleges that MD did not disclose a sale for $1,900,000 during the prior
year. Id. at 23, ¶ 50.
4 Id.
5 Id. at 24, ¶ 51.
6 Id.
7 Id.
Case: 16-11997 Date Filed: 01/26/2018 Page: 6 of 29
industry event in March 2011, and informed her then that MD had won the bid to
supply helicopters to the Afghan military. Ms. Tilton was impressed with
Col. Vergez and began grooming him for a future role at MD; she also began
traveling regularly to Huntsville to meet with him. She told MD’s employees that
he “got us this Afghan contract, he has great connections and he will drive our
Army business.”8 From shortly after they met through early 2012, Col. Vergez
brought Ms. Tilton or other MD employees into numerous conversations with
Army personnel, including a meeting at the Pentagon with a Deputy Assistant
Secretary of Defense. He also facilitated conversations with foreign officials and
with private sector companies for MD. On Col. Vergez’s recommendation, MD
hired several staff people, including employees of other contractors and other
retiring Army officers.9 On one occasion, he provided Ms. Tilton with
competition-sensitive information about forthcoming solicitations and leaked
requests from a foreign government to NSRWA.
The complaint also alleges that Col. Vergez anticipated retirement from
active service in late 2012. While his actions for MD’s benefit were ongoing,
Ms. Tilton and Col. Vergez discussed, over the course of approximately a year, his
own future employment at MD or at Patriarch. In February 2012, Col. Vergez
8 Id. at 15, ¶ 25.
9 Among those recommended by Col. Vergez was Ben Weiser, the executive vice
president who challenged Ms. Tilton on the Saudi Arabian National Guard contract.
Case: 16-11997 Date Filed: 01/26/2018 Page: 7 of 29
notified the Army of his disqualification from engaging in procurement activities
involving MD because he had an offer of future employment from the company.
During the following month, Col. Vergez participated in talks with MD and a
private helicopter vendor, toured an MD facility with them, and signed in as a
representative of the Army. In summer 2012, Col. Vergez signed a written
employment contract with Patriarch to direct, at a salary more than double his
military base pay, MD’s Civil and Military Programs. Mr. Marsteller had a
conversation with an MD manager during this period in which both agreed that the
employment relationship was illegal.10
Col. Vergez took terminal leave status in November 2012, but remained on
active duty until May 2013. In December 2012, during a plant-wide meeting, Ms.
Tilton introduced him to MD employees as “a very special person who had been
very influential in MD’s receipt of Army contracts.”11 On February 1, 2013, the
Colonel assumed a position as head of all of MD’s programs, reporting directly to
the COO, Schopfer. An internal organizational chart disclosed this arrangement,
but to disguise the relationship, Col. Vergez was, on paper, a Patriarch employee
with a Patriarch phone and email and receiving a Patriarch salary. In April 2013,
10 It appears that the MD employees were concerned about the provisions of federal
ethics laws applying to procurement officials and post-government employment with contractors.
See generally 41 U.S.C. § 2104.
11 R.57 at 29, ¶ 66.
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Col. Vergez told one of the relators, Mr. Swisher, then an MD employee, that all
military submissions were to go through him first. This directive provoked
Mr. Swisher to resign over the improper relationship.12
In its prayer for relief, the complaint also specifically alleges that, in
submitting a bid and later in submitting invoices for payment, MD certified that it
had complied with certain requirements applicable to government contractors, but
that the company had no intention of complying with these requirements. Several
of the counts also assert that, through lack of candor regarding both ethics and
price disclosure requirements, MD deprived the Army of its ability to negotiate a
reasonable price and, consequently, the Army agreed to terms it otherwise would
not have.
12 Subsequent to the filing of the complaint, Col. Vergez pleaded guilty to two counts of
making false statements, in violation of 18 U.S.C. § 1001, and one count of conflict of interest,
in violation of 18 U.S.C. §§ 208, 216(a)(2). Col. Vergez disputes the relevance of his guilty plea,
which the relators submitted in the district court as an attachment to their brief in opposition to
his motion to dismiss. Col. Vergez’s brief on appeal discusses the circumstances of his
conviction at some length. One of the convictions related to a failure to disclose his employment
with MD on an ethics disclosure form and to disclose $30,000 in relocation expenses received
from MD. Another of his convictions, for conflict of interest, relates to his involvement in
negotiating favorable payment terms for MD in the Saudi Arabian National Guard contract after
he had accepted an offer with an MD affiliate. The remaining count was unrelated to MD and
this action. Following oral argument, the parties also submitted judicial orders disposing of
various other unrelated claims involving Ms. Tilton and her investment practices, including an
SEC action resolved in her favor and a state court decision in Delaware resolved against her.
None of these facts bears on our current assessment of the legal sufficiency of the complaint.
Case: 16-11997 Date Filed: 01/26/2018 Page: 9 of 29
In 2013, relators brought this qui tam action in the Northern District of
Alabama. The United States declined to intervene. The defendants filed a motion
to dismiss, and, prior to a ruling on that motion, the relators filed an amended
complaint. The amended complaint sets forth the facts as we have just described
them. It then set forth six claims for relief: five FCA claims, one for each of the
contracts, and one additional conspiracy claim. The relators claimed that the
defendants had not complied, nor intended to comply, with the Contractor Code of
Business Ethics and Conduct (“Contractor Code of Ethics”), see 48 C.F.R.
§ 52.203-13, or with the Truth in Negotiations Act, 10 U.S.C. § 2306a. They also
alleged that the defendants’ implicit promise of compliance had influenced the
Government’s initial decision to enter into the contracts and its later decision to
pay out claims. The Defendants again moved to dismiss.
In ruling on the motion to dismiss the first amended complaint, the district
court had to rule on the viability and possible scope of the implied certification
theory. Under this theory, a party “impliedly certifies compliance with underlying
contractual or statutory duties when submitting claims to the government” such
that “[a] violation of those duties thus renders the claims false for purposes of the
FCA.” United States ex rel. Osheroff v. Humana, Inc., 776 F.3d 805, 808 n.1 (11th
Cir. 2015). In undertaking this task, the district court faced a daunting legal
Case: 16-11997 Date Filed: 01/26/2018 Page: 10 of 29
landscape. Our published cases “express[ed] no opinion as to the viability” of the
implied certification theory. Id. To compound the district court’s dilemma, our
sister circuits disagreed on the validity and scope of the implied certification
theory. The Seventh Circuit had rejected the theory entirely. See United States v.
Sanford-Brown, Ltd., 788 F.3d 696, 711–12 (7th Cir. 2015), vacated sub nom.
United States ex rel. Nelson v. Sanford-Brown, Ltd., 136 S. Ct. 2506 (2016)
(remanding for reconsideration in light of Escobar), aff’d, 840 F.3d 445. Other
courts, including the Second Circuit, had accepted it, but had cabined its
application to “cases where defendants fail to disclose violations of expressly
designated conditions of payment.” Escobar, 136 S. Ct. at 1999 (citing Mikes v.
Straus, 274 F.3d 687, 700 (2d Cir. 2001)). Still others, including the District of
Columbia Circuit, had held “that conditions of payment need not be expressly
designated as such to be a basis for False Claims Act liability.” Id. (citing United
States v. Sci. Applications Int’l Corp., 626 F.3d 1257, 1269 (D.C. Cir. 2010)).
Because these pre-Escobar cases shed an important cross-light on the district
court’s decision and therefore aid substantially in our understanding of the course
it chose, we pause briefly to review in somewhat more detail the different
perspectives that formed the legal landscape at that time. We begin with the
Second Circuit’s decision in Mikes v. Straus, 274 F.3d 687 (2d Cir. 2001). Mikes
involved an FCA claim by a dismissed employee of a pulmonology practice. She
Case: 16-11997 Date Filed: 01/26/2018 Page: 11 of 29
charged that her former employers did not maintain their equipment or perform
certain tests consistent with industry-standard guidelines. She alleged that the
defendants had expressly and impliedly certified compliance with these standards
when submitting claims for reimbursement to the Medicare and Medicaid
programs. The Second Circuit concluded that although the claims for payment
certified that the tests were “medically necessary,” that certification did not equate
to an express certification that the tests were performed in compliance with
industry standards. Id. at 698. While accepting the implied certification theory, the
Second Circuit saw a danger in its being read “expansively and out of context.” Id.
at 699. In particular, the court believed the theory was a poor fit in the medical
context; it saw a risk of “federaliz[ing] . . . medical malpractice.” Id. at 700.
Accordingly, it decided to apply the theory “only when the underlying statute or
regulation upon which the plaintiff relies expressly states the provider must comply
in order to be paid.” Id. (emphasis in original).
The District of Columbia Circuit took a different approach to implied
certification. In United States v. Science Applications International Corp., 626
F.3d 1257 (D.C. Cir. 2010), the underlying contract was between the Nuclear
Regulatory Commission and the defendant, “a scientific, engineering, and
technology applications company.” Id. at 1261. The contract was “to provide
technical assistance and expert analysis to support the agency’s potential
Case: 16-11997 Date Filed: 01/26/2018 Page: 12 of 29
rulemaking” on the release of radioactive waste at a contamination level that was
“below ‘regulatory concern.’” Id. The contractual arrangement included
“provisions designed to identify and prevent potential conflicts of interest,”
including requiring the defendant to forego outside contracts that created a conflict
and to disclose any potential conflicts. Id. at 1262. Regulations defined these
conflicts. In executing the contract, the defendant had certified compliance with the
requirements, which the contract did not identify as conditions of payment. The
defendant did not include an express certification of compliance when it later
requested payment. In a subsequent FCA action alleging conflicts of interest
involving the defendant’s business, the District of Columbia Circuit rejected the
Mikes approach. Instead, it adopted a rule that an FCA plaintiff may state a cause
of action against a federal contractor who “withheld information about its
noncompliance with material contractual requirements” and that “express
contractual language specifically linking compliance to eligibility for payment” is
not “a necessary condition.” Id. at 1269.
The District of Columbia Circuit thereafter acknowledged that although the
implied certification theory could be prone to abuse, any “concern can be
effectively addressed through strict enforcement of the Act's materiality and
Case: 16-11997 Date Filed: 01/26/2018 Page: 13 of 29
scienter requirements.” Id. at 1270.13 Referring to the facts before it and to the
issue of materiality, the court distinguished the conflict of interest rules from “any
of ‘potentially hundreds of legal requirements established by contract’” which
were “minor” or “merely ancillary to the parties’ bargain.” Id. at 1271. It then cited
record evidence that the conflict of interest obligations “were important to the
overall purpose of the contract.” Id. (quoting United States v. Sci. Applications
Int’l Corp., 653 F. Supp. 2d 87, 103 (D.D.C. 2009), aff’d in part and vacated in
part, 626 F.3d 1257).
Operating within this legal backdrop, the district court granted the motion. It
decided that the amended complaint failed to state a claim under the general
pleading standards of Rule 8 and, because the complaint alleged fraud, under the
particularity requirements of Rule 9(b). Turning to the relators’ implied
certification theory of liability, the court considered the defendants’ contention that
“noncompliance with [a] statute or regulation may form the basis of an FCA claim
13 The court provided an example to illustrate “[t]he logic of [its] conclusion” that the
express condition approach was too restrictive, in a way that was “freed from the complexities”
and “intricacies” of the case before it. United States v. Sci. Applications Int’l Corp., 626 F.3d
1257, 1269 (D.C. Cir. 2010). The court surmised that the Government enters into a contract with
a company that will provide gasoline with an octane rating of ninety-one or higher. The company
provides noncompliant lower octane gasoline and seeks reimbursement on a form that nowhere
requires certification of the octane level. An appropriate plaintiff could bring an FCA claim on
these facts, the court noted, as the octane rating would be material to the contract even if not an
express condition of payment, and even if the company did not separately certify that it satisfied
that requirement. Importantly, the discussion was not defining the outer limits of materiality, but
merely demonstrating that an FCA action is available on an implied certification theory even
absent an express designation as a condition of payment, where the requirement plainly satisfies
Case: 16-11997 Date Filed: 01/26/2018 Page: 14 of 29
under an implied certification theory only where the government expressly
conditioned payment on compliance.”14 The Government, in its statement of
interest filed in the district court, noted a recent trend away from the Mikes line of
cases and urged the district court to follow those more recent authorities.15
The court declined the Government’s suggestion to limit the restrictive
reading of the implied certification theory found in Mikes. Instead, it relied on an
unpublished decision of this court where we had described the implied certification
theory as recognizing “that the FCA is violated where compliance with a law, rule,
or regulation is a prerequisite to payment” and a participant makes a claim for
payment despite a knowing failure to comply with that condition.16 The district
court next inquired whether either the Contractor Code of Ethics or the Truth in
14 R.77 at 9.
15 Specifically, the Government noted that several circuits had concluded that Mikes
involved Medicare-specific considerations and should not be applied to all contexts, or that the
express condition rule did not have a basis in the text of the Act. See R.70 at 5–7 (citing United
States ex rel. Badr v. Triple Canopy, Inc., 775 F.3d 628, 637 n.5 (4th Cir. 2015), vacated by 136
S. Ct. 2504 (2016) (remanding for reconsideration in light of Escobar), remanded to 857 F.3d
174 (4th Cir. 2017) (affirming the prior opinion applying the standards of Escobar); United
States ex rel. Hutcheson v. Blackstone Med., Inc., 647 F.3d 377, 388 (1st Cir. 2011); Sci.
Applications Int’l Corp., 626 F.3d 1257; United States ex rel. Hendow v. Univ. of Phoenix, 461
F.3d 1166, 1177 (9th Cir. 2006)). Although the Government took no position on the viability of
the complaint itself, it “respectfully urge[d] the Court not to adopt the atextual position that
implied certification False Claims Act liability for non-compliance with a contract provision
(including regulatory or statutory provisions incorporated therein) necessarily hinges on the
presence of an express statement within that provision that payment is conditioned on its
compliance.” Id. at 7.
16 R.77 at 10–11 (emphasis in original); United States ex rel. Keeler v. Eisai, Inc., 568 F.
App’x 783, 799 (11th Cir. 2014) (unpublished).
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Negotiations Act was an express condition of payment and concluded that they
were not. The court found “no provision” in any of the relevant contracts “that
prohibits payment in the event of noncompliance” with either requirement.17
The court then stated that even if the express condition of payment approach
embodied in Mikes were incorrect, the relators’ claim would still fail under the
more generous standards of Science Applications International Corp., 626 F.3d at
1269. The district court could find no “‘objective requirements’ in the contract that
MD ‘failed to provide,’ or that MD ‘continued to bill the Government with the
knowledge that it was not providing the contract’s requirements.’”18
The court noted in a footnote that, although the response to the motion to
dismiss had argued a fraud in the inducement theory of liability as well, it was
absent from the pleadings. It further determined, without elaboration, that such a
claim would “fail for the same reasons” as the implied certification claims and
because it failed to meet the particularity standards of Rule 9(b).19 Finally, the
court held that in light of the dismissals of all substantive claims, the conspiracy
claim also must fail.
17 R.77 at 11; see also id. at 17–18.
18 Id. at 13 (quoting Triple Canopy, 775 F.3d at 638).
19 Id. at 7 n.2.
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The relators now appeal. They submit that the district court erred in rejecting
their fraud in the inducement and implied certification theories of FCA liability.
The Government has declined to intervene, but has filed a brief as amicus curiae.
Although it takes no position on the sufficiency of the complaint, it contends that
contractors who engage in the type of behavior alleged here can be liable under
either an implied certification theory or a fraud in the inducement theory. MD,
Patriarch, and Ms. Tilton have filed a brief addressing all of the relators’ claims.
Col. Vergez, named in the conspiracy count, has filed a separate brief focusing
primarily on that count.
The basic standards that must guide our analysis are well established. “We
review de novo the district court’s grant of a motion to dismiss for failure to state a
claim under Fed. R. Civ. P. 12(b)(6), accepting the allegations in the complaint as
true and construing them in the light most favorable to the plaintiff.” Timson v.
Sampson, 518 F.3d 870, 872 (11th Cir. 2008) (per curiam). Generally, “[t]o survive
a motion to dismiss, a complaint need only present sufficient facts, accepted as
true, to ‘state a claim to relief that is plausible on its face.’” Renfroe v. Nationstar
Mortg., LLC, 822 F.3d 1241, 1243 (11th Cir. 2016) (quoting Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 570 (2007)). However, we also have stated clearly that, in
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a qui tam action, the enhanced pleading requirements of Rule 9(b) apply. See
United States ex rel. Clausen v. Lab. Corp. of Am., Inc., 290 F.3d 1301, 1309–10
(11th Cir. 2002). “[U]nder Rule 9(b) allegations of fraud ‘must include facts as to
time, place, and substance of the defendant’s alleged fraud.’” Id. at 1308 (quoting
United States ex rel. Cooper v. Blue Cross & Blue Shield of Fla., Inc., 19 F.3d 562,
567 (11th Cir. 1994) (per curiam)).
The relators submit that the district court erred in dismissing claims based on
an implied certification theory and based on a fraud in the inducement theory. We
will address in turn each of these contentions. Before we focus on these particular
contentions, however, we will set forth the governing statutory language and
examine the Supreme Court’s holding in Escobar, 136 S. Ct. 1989, which, as we
have noted earlier, was decided after the district court rendered its decision in this
The FCA imposes significant financial liability on any person who
“knowingly presents, or causes to be presented, a false or fraudulent claim for
payment or approval,” or “knowingly makes, uses, or causes to be made or used, a
false record or statement material to a false or fraudulent claim.” 31 U.S.C.
§ 3729(a)(1)(A)–(B).
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Following the district court’s dismissal of relators’ first amended complaint,
the Supreme Court decided Escobar. This decision examines a claim of FCA
liability based on the implied certification theory. It is also helpful in assessing the
relators’ fraud in the inducement theory. In Escobar, the relators were the parents
of a disabled teenager who died from an adverse reaction to medication provided to
treat a diagnosis of bipolar disorder. A mental health facility operated by Universal
Health had treated their daughter prior to her death and then had sought
reimbursement for her treatment through the Medicaid program. The parents
alleged in their complaint that Universal Health submitted its itemized claims to
Medicaid by employing standard reimbursement codes. These codes, continued the
complaint, “made representations about the specific services provided by specific
types of professionals,” but “failed to disclose serious violations of regulations
pertaining to staff qualifications and licensing requirements for these services.” Id.
at 1998.
The rules of the Massachusetts Medicaid program, which paid the claims,
required “satellite facilities to have specific types of clinicians on staff,
delineate[d] licensing requirements for particular positions (like psychiatrists,
social workers, and nurses), and detail[ed] supervision requirements for other
staff.” Id. Although five separate practitioners treated the relators’ daughter, only
one of the five had a license. Another who held herself out as a psychologist with a
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Ph.D. had received her degree from an unaccredited institution, and the state
licensing board had rejected her credentials. The prescriber of the medication that
prompted the fatal reaction held herself out as a psychiatrist, but “was in fact a
nurse who lacked authority to prescribe medication absent supervision.” Id. at
1997. The relators’ complaint alleged that the requests for payment constituted a
false claim because inherent in the use of the codes was a certification that the care
provided satisfied the requirements for payment set by the Medicaid program.
The Court held “that the implied false certification theory can, at least in
some circumstances, provide a basis for liability.” Id. at 1999. Specifically,
“[w]hen, as here, a defendant makes representations in submitting a claim but
omits its violations of statutory, regulatory, or contractual requirements, those
omissions can be a basis for liability if they render the defendant's representations
misleading with respect to the goods or services provided.” Id. Because the
statutory text does not include an independent definition of “false or fraudulent,”
the Court applied the usual interpretive principle that Congress intended to
incorporate settled common law meanings. Id. At common law, “fraud has long
encompassed certain misrepresentations by omission.” Id. The Court declined to
“resolve whether all claims for payment implicitly represent that the billing party is
legally entitled to payment.” Id. at 2000. But it held that Universal Health’s claims
“fall squarely within the rule that half-truths—representations that state the truth
Case: 16-11997 Date Filed: 01/26/2018 Page: 20 of 29
only so far as it goes, while omitting critical qualifying information—can be
actionable misrepresentations.” Id. In its view,
the implied certification theory can be a basis for liability, at least
where two conditions are satisfied: first, the claim does not merely
request payment, but also makes specific representations about the
goods or services provided; and second, the defendant’s failure to
disclose noncompliance with material statutory, regulatory, or
contractual requirements makes those representations misleading
Id. at 2001. In so holding, the Court explicitly noted the Mikes v. Straus line of
cases, relied upon by the district court in this case, and rejected its approach.
The Court went on to emphasize that, “[u]nder the Act, the
misrepresentation must be material to the other party’s course of action” and that
the Act’s scienter requirement means that a plaintiff must show that the defendant
had actual knowledge of or recklessly disregarded a condition’s materiality. Id.
The statutory definition of materiality, “having a natural tendency to influence, or
be capable of influencing, the payment or receipt of money,” id. at 2002 (quoting
31 U.S.C. § 3729(b)(4)), focuses the inquiry on “the effect on the likely or actual
behavior of the recipient of the alleged misrepresentation.” Id. (emphasis added).
The designation of a statutory, regulatory, or contractual provision as a condition
of payment is “relevant, but not automatically dispositive,” because the FCA “is
not ‘an all-purpose antifraud statute’” which “punish[es] garden-variety breaches
of contract or regulatory violations.” Id. at 2003 (quoting Allison Engine Co. v.
Case: 16-11997 Date Filed: 01/26/2018 Page: 21 of 29
United States ex rel. Sanders, 553 U.S. 662, 672 (2008)). Materiality therefore is
not established by showing “that the Government would have the option to decline
to pay if it knew of the defendant's noncompliance” or where noncompliance “is
minor or insubstantial.” Id. The materiality standard is “demanding,” id., and
“rigorous,” id. at 1996, 2002. The Court concluded,
In sum, when evaluating materiality under the False Claims
Act, the Government’s decision to expressly identify a provision as a
condition of payment is relevant, but not automatically dispositive.
Likewise, proof of materiality can include, but is not necessarily
limited to, evidence that the defendant knows that the Government
consistently refuses to pay claims in the mine run of cases based on
noncompliance with the particular statutory, regulatory, or contractual
requirement. Conversely, if the Government pays a particular claim in
full despite its actual knowledge that certain requirements were
violated, that is very strong evidence that those requirements are not
material. Or, if the Government regularly pays a particular type of
claim in full despite actual knowledge that certain requirements were
violated, and has signaled no change in position, that is strong
evidence that the requirements are not material.
Id. at 2003–04.20
Escobar therefore clarified two central and interrelated principles of FCA
liability. First, the implied certification theory can be a premise of liability at least
where a party, in requesting payment, makes certain representations which are
20 To illustrate its point about the limits of materiality, the Court hypothesized a contract
for health services that required providers to use American-made staplers. If the Government
routinely paid claims, irrespective of whether it knew of the use of foreign staplers and even
though it had the right to withhold payment, the provision would not be material; False Claims
Act liability would not attach. A contrary rule would be “an extraordinarily expansive view” of
fraud liability not justified by the statute. Universal Health Services, Inc. v. United States ex rel.
Escobar, 136 S. Ct. 1989, 2004 (2016).
Case: 16-11997 Date Filed: 01/26/2018 Page: 22 of 29
misleading because of the omission of violations of statutory, regulatory, or
contractual requirements; any such requirement need not be an express condition
of payment for liability to attach. Second, such an omission, to be actionable, must
be material.
We now apply these principles to the complaint before us. The relators
allege a series of improprieties in the relationship between Ms. Tilton, MD, and
Patriarch, on the one hand, and Col. Vergez, an officer with authority in the
NSRWA contracting office on the other. Those improprieties, they contend,
amount to potential violations of criminal law involving fraud, conflict of interest,
bribery, or gratuity violations. The Contractor Code of Ethics, which is part of the
Federal Acquisitions Regulations and is a mandatory term of acquisitions
contracts, requires disclosure of any credible evidence of such conduct. The Truth
in Negotiations Act sets forth certain disclosure requirements that assist the
Government in determining the market value of the products it purchases, which
the relators submit, “naturally affect[s] the government’s negotiation posture.”21
The relators contend, at some length in their brief, that the Government considers
these terms essential and that compliance goes directly to the integrity of the
contracting process.
21 Appellants’ Amended Br. 42–43.
Case: 16-11997 Date Filed: 01/26/2018 Page: 23 of 29
We believe it is appropriate to afford the district court the opportunity to
reconsider the allegations in light of the changed legal landscape. Escobar makes
clear that the district court’s principal method for evaluating implied certification
claims, under Mikes, is no longer appropriate. The Supreme Court explicitly
rejected a standard for implied certification claims that focuses exclusively on
whether the Government expressly designates a contractual, statutory, or
regulatory obligation as a condition of payment. Whether a condition is so
designated is “relevant to but not dispositive of the materiality inquiry,” but not a
precondition to the theory of liability itself. Id. at 2001 (emphasis added).
Escobar now provides the district court with a more refined framework to
address the questions before it. The definition of “material” contained within the
statute considers whether the misrepresentation had “a natural tendency to
influence, or be capable of influencing, the payment or receipt of money or
property,” 31 U.S.C. § 3729(b)(4), a definition “descend[ed] from ‘common-law
antecedents,’” Escobar, 136 S. Ct. at 2002 (quoting Kungys v. United States, 485
U.S. 759, 769 (1988)). Escobar instructs courts to consider whether
noncompliance is “minor or insubstantial” and amounts to “garden-variety
breaches of contract or regulatory violations,” or, conversely, whether the
Government would have attached importance to the violation in determining
whether to pay the claim. Id. at 2002–03 (citing 26 Richard A. Lord, Williston on
Case: 16-11997 Date Filed: 01/26/2018 Page: 24 of 29
Contracts § 69:12 (4th ed. 2003); Restatement (Second) of Torts § 538 (Am. Law
Inst. 1977)).
We believe that the district court ought to reconsider this case for another
reason: given the advent of Escobar, the district court may decide that, in fairness
to the relators, they should have an opportunity to replead their allegations in light
of the Supreme Court’s guidance.22
The relators also challenge the district court’s conclusion, expressed in a
footnote, that the complaint failed to allege fraud in the inducement. The district
court did not discern that theory to be in the complaint. If it were in the complaint,
continued the court, it failed “for the same reasons” as the implied certification
theory, and because the allegations were insufficient under the particularity
standards for fraud of Rule 9(b).23
Claims alleging fraudulent inducement to support an FCA action derive
from United States ex rel. Marcus v. Hess, 317 U.S. 537 (1943), superseded in part
on other grounds as noted in Schindler Elevator Corp. v. United States ex rel.
22 Our resolution of the substantive claims equally affects the allegations concerning the
conspiracy count.
23 R.77 at 7 n.2. Although the label of fraudulent inducement does not appear on the face
of the complaint, neither does the label of implied certification. Nor does a plaintiff’s labeling of
their complaint bind us. See Johnson v. City of Shelby, 135 S. Ct. 346, 346 (2014) (per curiam)
(noting that federal pleading rules “do not countenance dismissal of a complaint for imperfect
statement of the legal theory supporting the claim asserted”).
Case: 16-11997 Date Filed: 01/26/2018 Page: 25 of 29
Kirk, 563 U.S. 401, 412 (2011). Marcus involved a request for competitive bids for
Public Works Administration projects. Electrical contractors colluded to ensure
that there would be no price competition. The Court found that the collusion was a
“fraud” that satisfied the Act and that the “fraud did not spend itself with the
execution of the contract.” Id. at 543. That is, the original fraud that influenced the
Government’s decision to enter into a particular contract at a particular price
“pressed ever to the ultimate goal—payment of government money to persons who
had caused it to be defrauded.” Id. at 543–44. The contractor’s ultimate claims for
payment were “grounded in fraud” when the Government paid them, even though
the “fraud” occurred prior to the execution of the contract itself. Id. at 544. As one
of our sister circuits has recognized, subsequent claims are false “because of an
original fraud (whether a certification or otherwise).” United States ex rel. Hendow
v. Univ. of Phoenix, 461 F.3d 1166, 1173 (9th Cir. 2006) (emphasis in original).24
24 Other circuits have conceptualized such claims somewhat differently under this statute,
although still acknowledging their validity:
The False Claims Act covers anyone who “knowingly makes, uses, or
causes to be made or used, a false record or statement to get a false or fraudulent
claim paid or approved by the Government[.”] 31 U.S.C. § 3729(a)(2). The
[defendant] “uses” its [initial fraudulent statement] when it makes . . . [an]
application for payment. No more is required under the statute. . . . The statute
requires a causal rather than a temporal connection between fraud and payment. If
a false statement is integral to a causal chain leading to payment, it is irrelevant
how the federal bureaucracy has apportioned the statements among layers of
United States ex rel. Main v. Oakland City Univ., 426 F.3d 914, 916 (7th Cir. 2005) (citation
Case: 16-11997 Date Filed: 01/26/2018 Page: 26 of 29
We agree with Government as amicus curiae that the allegations of the
relators’ complaint could support multiple theories of fraud in the inducement.
First, the allegations can be read to support the view that the prospective promise
to comply with various provisions of law, including the Contractor Code of Ethics
and the Truth in Negotiations Act, were false when made. The Government would
not have entered into those had it known of the defendants’ unwillingness to
comply with these rules. The allegations also support the view that, on at least
some occasions, MD provided incomplete pricing data to the Government. This
incomplete data induced the Government to enter contracts on terms more
favorable to MD than it would have had the pricing data been complete. Indeed,
the complaint is explicit on this point. With respect to several of the contracts, the
relators allege that the Army requested pricing data, that MD provided
misleadingly incomplete data to support an inflated price, and that the Government
relied on the data in awarding the contract.25 The Government also asserts that the
undisclosed conflicts of interest while MD and Col. Vergez were negotiating their
future relationship might have caused the Army to accept an inflated contract price.
MD’s response to these allegations, that the Government is not necessarily entitled
to the best price commercially available, is unavailing. Here, the concern is
25 See, e.g., R.57 at 18–19, ¶ 33; 35, ¶ 91 (relating to the El Salvador contract).
Case: 16-11997 Date Filed: 01/26/2018 Page: 27 of 29
whether the pricing data was misleadingly incomplete such that it amounted to
fraud, and whether that data was material to the Government’s decisions on the
contracts. As Escobar reminds us, “fraud” at common law has long included
“misrepresentations by omission” such as the above. 136 S. Ct. at 1999.
The district court also concluded that, even if the complaint did include a
fraudulent inducement theory, such a claim would fail for the “same reasons” as
the implied certification claims. We have concluded that, in light of Escobar, the
district court should evaluate anew the implied certification claims, both with
respect to the fraudulent statements and with respect to materiality. More
fundamentally, it is far from self-evident that the court’s assessment of the implied
certification theory should control its disposition of the fraudulent inducement
theory. Each theory of liability rests on different factual allegations. Finally, we are
not convinced that the court’s brief mention of a failure under Rule 9(b)’s
specificity requirement accurately assesses the relators’ detailed forty-five-page
The district court decided the motion to dismiss in a profoundly uncertain
legal environment. The Supreme Court now has provided significant guidance. The
correct course is to allow the district court to consider this matter in light of that
guidance. On remand, the district court also should consider whether to allow the
Case: 16-11997 Date Filed: 01/26/2018 Page: 28 of 29
plaintiffs to file a second amended complaint that conforms its allegations to the
requirements of Escobar. We also conclude that the complaint did plead fraud in
the inducement, and we therefore remand so that the district court can reexamine
the allegations relating to that theory.


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