United States ex rel. Tessler v. City of New York

712 F. App'x 27
CourtCourt of Appeals for the Second Circuit
DecidedOctober 5, 2017
Docket17-178-cv
StatusPublished
Cited by31 cases

This text of 712 F. App'x 27 (United States ex rel. Tessler v. City of New York) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States ex rel. Tessler v. City of New York, 712 F. App'x 27 (2d Cir. 2017).

Opinion

SUMMARY ORDER

Plaintiff-appellant Akiva Tessler, proceeding pro se, appeals from a judgment entered December 20, 2016, dismissing his qui tam action brought under the False Claims Act (the “FCA”), 31 U.S.C. §§ 3729-3733, against defendant-appellee City of New York (the “City”)- Tessler’s second amended complaint (the “SAC”) asserted two categories of claims. First, it alleged that the City failed to recoup over-payments of benefits for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families Program, as required by statute and regulations, and then sought reimbursement for those overpayments from the Government (the “aid-to-continue claims”). Second, it alleged that the City failed to redetermine the eligibility of recipients to participate in a Medicare Savings Program (the “MSP claims”). By opinion and order entered December 16, 2016, the district court granted the City’s motion to dismiss the SAC for failure to state a claim. We assume the parties’ familiarity with the underlying facts, the procedural history of the case, and the issues on appeal.

We review de novo the dismissal of a complaint pursuant to Federal Rule of Civil Procedure 12(b)(6), accepting all factual allegations as true and drawing all reasonable inferences in the plaintiffs favor. Biro v. Conde Nast, 807 F.3d 541, 544 (2d Cir. 2015). The complaint must plead “enough facts to state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007); see also Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). Although a court must accept as true all factual allegations in the complaint, that requirement does not apply to legal conclusions. Iqbal, 556 U.S. at 678, 129 S.Ct. 1937.

The FCA imposes civil liability on “any person who ... knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval.” 31 U.S.C. § 3729(a). “[F]raud under the FCA has two components: the defendant must submit or cause the submission of a claim for payment to the government, and the claim for payment must itself be false or fraudulent.” United States ex rel. Chorches as Trustee for Bankr. Estate of Fabula v. Am. Med. Response, Inc. (“Fabula”), 865 F.3d 71, 83 (2d Cir. 2017) (alteration in original) (quoting Hagerty ex rel. United States v. Cyberonics, Inc., 844 F.3d 26, 31 (1st Cir. 2016)).

FCA complaints are subject to Federal Rule of Civil Procedure 9(b), which provides that “[i]n alleging fraud ..., a party must state with particularity the circumstances constituting fraud.” Fabula, 865 F.3d at 81 (alteration in original) (quoting Fed. R. Civ. P. 9(b)). “That ordinarily requires a complaint alleging fraud to (1) specify the statements that the plaintiff contends were fraudulent, (2) identify the speaker, (3) state where and when the statements were made, and (4) explain why the statements were fraudulent.” Id. (citation and quotation marks omitted). To comply with Rule 9(b), the complaint must be supported by more than “conclusory statements” or “hypotheses,” and it must set, forth “particularized allegations of fact.” See United States ex rel. Ladas v. Exelis, Inc., 824 F.3d 16, 26-27 (2d Cir. 2016). Rule 9(b) permits scienter to be averred generally, but “we have repeatedly required plaintiffs to plead the factual basis which gives rise to a strong inference of fraudulent intent.” O’Brien v. Nat’l Prop. Analysts Partners, 936 F.2d 674, 676 (2d Cir. 1991) (internal quotation marks omitted); see also Universal Health Servs., Inc. v. United States ex rel. Escobar, — U.S. —, 136 S.Ct. 1989, 2002, 195 L.Ed.2d 348 (2016) (observing that FCA’s scienter requirement is “rigorous”).

I. Aid-to-Continue Claims

We agree with the district court that the SAC’s aid-to-continue claims failed to include particularized allegations of fact sufficient to satisfy Rule 9(b). The SAC alleges in conclusory fashion that there was a “custom and practice” at the City of not recouping aid-to-continue benefits, but it fails to provide particularized facts to support that assertion. Tessler does not, for example, set forth the origins or details of the custom and practice or identify the employees who purportedly implement it. Tessler provides a list of 28 hearings in which he observed that the recipient lost and alleges that the benefits were “required to be recouped” and “exceeded any relevant thresholds,” as well as statistics from a database showing few fair hearings addressing recoupment. Appellant’s Br. 24. But the SAC does not contain any details as to why these benefits were required to be recouped. Moreover, as the district court noted, under applicable law and guidelines, the City is not obligated to recoup overpayments unless they exceed certain thresholds. See 7 C.F.R. § 273.18(e)(2)(i); N.Y.S. Office of Temporary and Disability Assistance, Administrative Directive 05-ADM-15 (Sept. 6, 2005), available at https://otda.ny.gov/ policy/directives/2005/ADM/05-ADM-15. pdf; 18 N.Y.C.R.R. § 352.31(d)(5).

In Fabula, we clarified that a relator who has personal knowledge that records are falsified need not necessarily have personal knowledge that those records were actually submitted where the factual allegations made it highly plausible that the employer submitted falsified records. 865 F.3d at 82-86. Fabula, an emergency medical technician, alleged that his employer directed him to falsify patient care reports for ambulance transports so that they would qualify for Medicare reimbursement. Id. at 76-77. Fabula had no access to his employer’s billing department and therefore could not personally verify whether any of his reports were actually submitted to the Government. Id. at 82. We held that Fabula could plead submission on information and belief because submissions were uniquely within his employer’s knowledge and control and Fabula’s factual allegations made it highly plausible that Fabula’s employer submitted the falsified records. Id. at 83-86.

Unlike Fabula, however, Tessler fails to plausibly allege that the City submitted false or fraudulent claims for payment. Tessler lacked personal knowledge that the City failed to recoup the aid-to-continue overpayments to those recipients, and that the City submitted claims for federal reimbursement for any unrecouped over-payments. The SAC alleges only “hypotheses” and conclusory allegations. For these reasons, the SAC fails to plead the aid-to-continue claims with particularity as required by Rule 9(b).

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712 F. App'x 27, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-tessler-v-city-of-new-york-ca2-2017.