Buth v. Walmart Inc

CourtDistrict Court, E.D. Wisconsin
DecidedAugust 13, 2019
Docket2:18-cv-00840
StatusUnknown

This text of Buth v. Walmart Inc (Buth v. Walmart Inc) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Buth v. Walmart Inc, (E.D. Wis. 2019).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WISCONSIN

UNITED STATES OF AMERICA, ex rel. JENNIFER BUTH, et al.

Plaintiffs,

v. Case No. 18-CV-840

WALMART INC.

Defendant.

DECISION AND ORDER ON DEFENDANT’S MOTION TO DISMISS

Jennifer Buth brought this qui tam action1 against Walmart Inc. on behalf of the United States, thirty-one individual states, the District of Columbia, and the City of Chicago.2 (Docket # 1, Docket # 17.) Buth alleges that Walmart violated the False Claims Act (“FCA”), 31 U.S.C. § 3729, and similar state statutes through various pharmacy practices. (Docket # 1, Docket # 17.) Walmart has moved for dismissal for failure to state a claim on which relief can be granted. (Docket # 38.) For the reasons below, Walmart’s motion to dismiss will be granted in part and denied in part. LEGAL STANDARD To survive a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), a plaintiff must satisfy Rule 8(a) by providing a “short and plain statement of the claim

1 Private individuals (“relators”) may file civil actions on behalf of the United States (“qui tam actions”) to recover money the government paid as the result of an FCA violation. United States ex rel. Yannacopoulos v. General Dynamics, 652 F.3d 818, 822 (7th Cir. 2011) (citing Glaser v. Wound Care Consultants, Inc., 570 F.3d 907, 912 (7th Cir. 2009)). showing that the pleader is entitled to relief . . . in order to give the defendant fair notice of what the . . . claim is and the grounds upon which it rests.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 545 (2007) (quoting Conley vs. Gibson, 355 U.S. 41, 47 (1957)). Additionally, the allegations must suggest that the plaintiff is entitled to relief beyond the speculative level.

E.E.O.C. v. Concentra Health Services, Inc., 496 F.3d 773, 777 (7th Cir. 2007). I must construe the complaint “in the light most favorable to the plaintiff, taking as true all well-pleaded factual allegations and making all possible inferences from those allegations in his or her favor.” Lee v. City of Chicago, 330 F.3d 456, 459 (7th Cir. 2003). However, in deciding a motion to dismiss, I am not bound to accept as true legal conclusions couched as facts. Bonte v. U.S. Bank, N.A., 624 F.3d 461, 465 (7th Cir. 2010). FCA claims are subject to the heightened pleading requirements of Rule 9(b). United States ex rel. Presser v. Acacia Mental Health Clinic, LLC, 836 F.3d 770, 775 (7th Cir. 2016) (citing United States ex rel. Gross v. AIDS Research All.–Chi., 415 F.3d 601, 604 (7th Cir. 2005)).

Under Rule 9(b), a plaintiff alleging fraud must state with particularity the circumstances constituting fraud—the “who, what, when, where, and how.” Presser, 836 F.3d at 776 (quoting United States ex rel. Lusby v. Rolls–Royce Corp., 570 F.3d 849, 853 (7th Cir. 2009)) (internal quotation marks omitted). The precise details that must be included may vary depending on the facts of the case, and courts must “remain sensitive to information asymmetries that may prevent a plaintiff from offering more detail.” Pirelli Armstrong Tire Corp. Retiree Med. Benefits Tr. v. Walgreen Co., 631 F.3d 436, 443 (7th Cir. 2011) (citing In re Rockefeller Center Props., Inc. Sec. Litig., 311 F.3d 198, 216 (3d Cir. 2002)). Nevertheless,

2 The United States, thirty individual states, and the District of Columbia have elected not to intervene in this case at this time. (Docket # 48.) The City of Chicago forfeited its right to intervene, and the claim asserted on behalf of the State of Maryland was dismissed without prejudice. (Id.) plaintiffs must “use some . . . means of injecting precision and some measure of substantiation into their allegations of fraud.” Presser, 836 F.3d at 776 (quoting 2 James Wm. Moore et al., Moore’s Federal Practice § 9.03[1][b], at 9-22 (3d ed. 2015)); see also Pirelli, 631 F.3d at 442.

BACKGROUND Buth is a licensed pharmacist who worked as a pharmacy manager at Walmart’s New Berlin, Wisconsin pharmacy from July 2017 to May 2018. (Docket # 17 ¶¶ 27–28.) Walmart is a publicly traded Delaware corporation with its principal place of business in Arkansas, but doing business throughout all of the party states, the District of Columbia, and the City of Chicago. (Id. ¶ 63.) Medicare is a government healthcare program that pays for reasonable and necessary healthcare for beneficiaries. (Id. ¶ 69.) Under Medicare Part D, the government pays a percentage of the cost of covered drugs dispensed with valid prescriptions. (Id. ¶¶ 78, 84.)

The U.S. Department of Health and Human Services oversees the Medicare program and makes payments through the Center for Medicare and Medicaid Services (“CMS”). (Id. ¶ 72.) CMS does not pay pharmacies directly; it pays Medicare Part D “Plan Sponsors,” typically private insurance companies, who pay pharmacies directly or through intermediaries known as Pharmacy Benefit Managers (“PBMs”). (Id. ¶¶ 78–79.) When a pharmacy dispenses a drug to a Medicare beneficiary, it submits an electronic claim to the Plan Sponsor and receives payment for the price minus any portion that must be paid by the beneficiary. (Id. ¶ 80.) Walmart generates “Prescription Drug Event” (“PDE”) records to support its claims

for government payment, which it sends to CMS via PBMs and the Plan Sponsor. (Id. ¶ 87.) A PDE record must include accurate data including the drug dispensed, the prescription number, the dispensing fee paid to the pharmacy, the cost of the drug, the quantity dispensed, and the provider who ordered the medication. (Id. ¶ 88.) That such data be “true, accurate, and complete” is a condition of payment under the Medicare Part D program. (Id.

¶ 89.) Buth’s first amended complaint alleges that Walmart pharmacies nationwide defrauded the government through four “schemes”: 1) dispensing less medication than prescribed but billing for the full amount (“short-filling”); 2) dispensing and billing for more medication than necessary for a particular period (“days’ supply”); 3) dispensing and billing for 90-day supplies instead of 30-day supplies without consent or clinical need (“conversion”); and 4) billing for medications dispensed with inaccurate expiration dates. (Id. ¶¶ 143–283.) Buth asserts that these alleged schemes resulted in the submission of false claims and materially false PDE data to CMS and improper retention of money owed to the

government. (Id. ¶¶ 284–93.) ANALYSIS The FCA is the primary vehicle used by the government for recouping losses suffered through fraud. United States v.

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