Where the district court dismissed claims that Walgreen Co. misrepresented that certain patients met Virginia’s Medicaid-eligibility requirements for expensive Hepatitis C drugs on the basis that Virginia’s eligibility requirements violated the Medicaid Act, it erred. The complaint plausibly alleged that the misrepresentations did, in fact, influence the decisionmakers.
Background
The United States and the Commonwealth of Virginia allege that Walgreen Co. misrepresented that certain patients met Virginia’s Medicaid-eligibility requirements for expensive Hepatitis C drugs. They asserted claims under the False Claims Act and Virginia state law. The district court dismissed the complaint, holding that Virginia’s eligibility requirements violated the Medicaid Act, and therefore Walgreens’s misrepresentations were immaterial as a matter of law.
Analysis
To plausibly allege a claim under the False Claims Act, a plaintiff must generally plead four elements: “(1) there was a false statement or fraudulent course of conduct; (2) made or carried out with the requisite scienter; (3) that was material; and (4) that caused the government to pay out money or to forfeit moneys due.”
The district court and the parties took on the daunting question whether Virginia’s eligibility requirements violated the Medicaid Act. But this court doesn’t think it necessary to answer that question (at least at this point in the proceedings) because it doesn’t control materiality as a matter of law.
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