Heightened Standards and Procedural Bars: FCA Litigation Lessons From 2025

Key Takeaways

• Federal courts in 2025 raised the bar on who can bring FCA cases and when, strictly enforcing government dismissal authority, the first-to-file rule, and the public disclosure/original source bar — meaning many follow-on or copycat healthcare qui tam suits are being dismissed before reaching the merits.
• Heightened pleading and proof standards now dominate FCA healthcare litigation, with courts repeatedly throwing out complaints that allege broad “schemes” without tying them to specific false claims, particularized facts of falsity, scienter, and materiality, and reliable indicia that the government actually paid because of the alleged misconduct.
• Substantive FCA theories are being narrowed, especially around AKS causation, reverse false claims defenses, and retaliation, as courts demand but-for causation for AKS-based FCA claims in some circuits, a clear “obligation” for reverse false claims, and concrete notice and causation for retaliation. This reinforces the need for rigorous compliance programs, careful documentation, and early case assessment in FCA risk matters.

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The False Claims Act (“FCA”) imposes liability on anyone who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval to the federal government. 31 U.S.C.S. § 3729 (a)(1)(A). In 2025, federal appellate courts refined how FCA claims must be properly partied, pled, and proved. This survey of key decisions underscores courts’ increasing emphasis on procedural bars, heightened pleading requirements, and rigorous proof of falsity, scienter, and materiality in healthcare cases. If you have questions about how these developments affect your compliance strategy, our team is ready to explore strategies to help you navigate the risks.

Government Dismissal

Under § 3730(c)(1), when the government intervenes, it retains primary responsibility for prosecuting the action and is not bound by the relator’s acts. The relator may continue as a party — filing motions and conducting discovery — but only “subject to the limitations set forth in [§ 3730(c)(2)].” § 3730(c)(1). In Vanderlan v. United States, 135 F.4th 257 (5th Cir. 2025), the court reasoned that the statutory scheme shows that the government retains ultimate authority over qui tam litigation and affirmed the district court’s grant of the government’s motion to dismiss the relator’s action.

First-to-File Bar

The FCA bars anyone other than the government from bringing “a related action based on the facts underlying the pending action.” 31 U.S.C. § 3730(b)(5). In United States ex rel. Rosales v. Amedisys N.C., L.L.C., 128 F.4th 548 (4th Cir. 2025), Relator Rosales’s FCA claims against multiple defendants (Amedisys Holding, a North Carolina subsidiary, and others), were barred by the first-to-file rule because they alleged the same nationwide fraudulent scheme as a different relator’s earlier complaint against Amedisys Holding and a South Carolina subsidiary. The earlier complaint alerted the government to the same alleged fraud against the North Carolina subsidiary. Rosales’s amendment adding claims against a specific medical director and his medical practice did not salvage Rosales’ claims, as the prior relator’s complaint included allegations against Amedisys Holdings’ medical directors.

Public Disclosure Bar

A court must dismiss an FCA action “if substantially the same allegations or transactions as alleged in the action or claim were publicly disclosed . . . unless the action is brought by the Attorney General or the person bringing the action is an original source of the information.” 31 U.S.C. § 3730(e)(4)(A). An “original source” is “an individual who either (i) prior to a public disclosure under subsection (e)(4)(a), has voluntarily disclosed to the Government the information on which allegations or transactions in a claim are based, or (2) [(ii)] who has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions, and who has voluntarily provided the information to the Government before filing an action under this section.” Id. § 3730(e)(4)(B). Courts continued to apply the public disclosure bar strictly, as shown in the following cases.

United States ex rel. Winnon v. Lozano, 146 F.4th 1197 (D.C. Cir. 2025). Relator Winnon’s claims overlapped with a prior complaint that alleged that the defendants’ facility, RehabCare, ordered its program directors to assign ultra-high resource utilization group (“RUG”) levels to all new patients — without regard to clinical need — because higher Medicare reimbursements meant higher profits. Winnon’s complaint additionally claimed that the scheme spread to several SNFs where RehabCare systematically steered patients into inflated RUG levels. The court affirmed application of the public disclosure bar, finding that the central actor and scheme Winnon alleged were materially identical to the prior complaint and that Winnon’s “additional examples of an already exposed scheme [did] not breathe life into an otherwise barred claim.” Further, Winnon was not an original source because she did not allege with any specificity that she voluntarily provided the relevant information to the government before the prior action or filing her qui tam suit.

United States ex rel. Sam Jones Co., LLC v. Biotronik, Inc., 152 F.4th 946 (9th Cir. 2025). The plaintiff alleged that Biotronik had hired Brian Goodman as a sales representative because his brother, Dr. Jeffrey Goodman, was then implanting an extremely high volume of cardiac devices at Cedars-Sinai Medical Center in Los Angeles. According to the complaint, Brian recommended Biotronik devices to his brother, who implanted the devices at Cedars-Sinai, Cedars-Sinai billed federal public health insurance programs for the devices, and Biotronik paid Brian a commission on each sale. The district court dismissed the action as barred by prior New York Times’ reporting that Biotronik used various financial incentives to encourage physicians to use its cardiac rhythm management devices rather than devices sold by Biotronik’s competitors. Reversing, the appellate court found that the complaint included new, specific allegations not previously reported, such as Biotronik’s employing doctors’ family members as sales representatives and violations of the Stark Law and Anti-Kickback Statute (“AKS”). The court observed that while the news article generally suggested the practice alleged in the qui tam suit, it did not disclose the “critical mass of the underlying facts” in the plaintiff’s complaint.

United States ex rel. 3729, LLC v. Express Scripts, Inc., No. 23-55645, 2025 U.S. App. LEXIS 2453 (9th Cir. Feb. 4, 2025) (unpublished). The United States Court of Appeals for the Ninth Circuit determined that a whistleblower action accusing Express Scripts Inc. (“ESI”) of defrauding the U.S. Department of Defense (“DOD”) out of billions of dollars in unnecessary medications for military personnel wasn’t barred by any public disclosures of the alleged fraud. Under the regulations that apply to ESI’s participation in Tricare (DOD’s health insurance program), “fraud” presumptively includes billings or claims that involve flagrant and persistent overutilization of services without proper regard for results, the patient’s ailments, condition, medical needs, or the physician’s orders, or that are for services that would be covered except for the frequency or duration of the services. The district court barred relator’s complaint due to a military publication’s prior report that Tricare’s pharmacy benefit was wasting money by shipping unnecessary drugs or dispensing 90-day refills instead of 30-day refills. The report also described beneficiaries with drugs piled up in medicine cabinets. But the appellate court reasoned that the practices described in the report were not substantially similar to the transactions the relator alleged, which involved systematically shipping needed refills too early. Moreover, statements in the report did not disclose facts sufficient to infer that ESI was flagrantly or persistently overfilling prescriptions, without regard to need, by deliberately using a systematic practice of shipping 90 days’ worth of refills after 60 days.

Failure to Plead With Particularity

Because FCA claims allege fraud, they must meet heightened pleading standards beyond those that apply in ordinary civil actions. Specifically, Federal Rule of Civil Procedure 9(b) requires plaintiffs to state with particularity the circumstances constituting the fraud, a showing that generally requires details about the time, place, and manner of the fraud.

United States ex rel. Winnon v. Lozano, 146 F.4th 1197 (D.C. Cir. 2025). Relator Winnon alleged that the defendants schemed their way to improper reimbursement by: (1) paying off doctors and hospital discharge planners for patient referrals to skilled nursing facilities; and (2) inflating therapy patient classifications to maximize reimbursements. The court found that Winnon’s allegations regarding inducements to personnel lacked critical details necessary to state a plausible claim. She had failed to identify any specific agreements conditioning payment on referrals or connect any payments to actual claims submitted to Medicare or Medicaid. Without the missing details, the court could only “glean inferences — faintly, with squinted eyes.” Regarding Winnon’s inflated therapy billing claims, the court concluded that her reliance on statistical anomalies fell short of satisfying Rule 9(b)s heightened pleading standard, as she failed either to provide specific examples of improperly classified patients or explain how the fraudulent scheme was executed.

United States ex rel. Flanagan v. Fresenius Med. Care Holdings, Inc., 142 F.4th 25 (1st Cir. 2025). Relator alleged that Fresenius contracted to provide inpatient dialysis services to hospitals below cost to help secure outpatient dialysis patients after their hospital discharge. Fresenius also engaged hospital nephrologists who were in positions to refer high numbers of patients to Fresenius to serve as medical directors at Fresenius outpatient facilities, often paying them more than twice the salary as paid by Fresenius’s primary competitor in the same localities. According to Flanagan, Medicare regulations required that medical directors “devote sufficient time” to this position. Fresenius did not require its medical directors to document their time. Flanagan argued that Fresenius made false records by falsely certifying compliance with the AKS and listing the number of hours that medical directors worked. However, the Court found that Flanagan’s Complaint did not address what Fresenius actually submitted in the reports, either as to certifications or as to hours worked by medical directors, and failed to plead with particularity that Fresenius made false statements or records with intent that the government rely on them as a condition of payment.

United States v. Bracco USA, Inc., No. 24-1668, 2025 U.S. App. LEXIS 10505 (3d Cir. May 1, 2025) (unpublished). The relator alleged that Bracco provided free power machines to medical facilities in exchange for their agreement to purchase 90% of their imaging agents from Bracco for 30 years. The agreements required the providers to comply with the antikickback disclosure rules by accounting for the free machines in their cost reports to federal payors. The providers billed federal payors for imaging services and agents used with the free machines. The court found that though the relator had alleged in detail how the free machines could have been used to defraud the government, describing a mere opportunity for fraud would not suffice, and the relator did not plead with particularity any reliable indicia that the free machines were not disclosed to the government.

United States v. Fillmore Capital Partners, LLC, No. 24-1606, 2025 U.S. App. LEXIS 7502 (3d Cir. Apr. 1, 2025) (unpublished). The relator alleged that the defendant’s nursing home schemed to overbill federal payors by admitting high-acuity residents while understaffing facilities. But his allegations (supported by expert reports, affidavits from other nurses, and personal experience) did not provide reliable indicia of fraud. The court recognized that the nursing home had a financial incentive in minimizing, to the extent permitted by law and regulation, staffing and overhead costs to maximize its profits. Thus, the existence of a legitimate business explanation for the nursing home’s low staffing decision militated against any “strong inference” of fraud as required by the the court’s precedent.

Bennett v. Bayer Corp., No. 24-1807, 2025 U.S. App. LEXIS 8423 (3d Cir. Apr. 10, 2025) (unpublished). The relator alleged that pharmaceutical companies Bayer Corp. and Johnson and Johnson “had to have known” that certain antibiotics they manufactured caused serious side effects (including neurological and psychiatric damage), but misrepresented information about these side effects to the FDA. Per the relator, this fraudulently induced the FDA to approve the drugs without appropriate warning labels, leading to false claims being submitted to federal payors. The court observed that the relator failed to allege what, if anything, the defendants knew or withheld, offering only a “textbook Rule 9(b) pleading deficiency in the form of speculation.”

United States ex rel. Wheeler v. Acadia Healthcare Co., 127 F.4th 472 (4th Cir. 2025). Wheeler alleged that Acadia falsified therapy notes for group and individual sessions that were never provided. She provided multiple examples of false therapy notes that were repeatedly used to falsify patient records, identified Acadia staff who created and signed the notes, and specified the dates and descriptions of the fictitious therapy sessions. But the court only approved Wheeler’s claims regarding Acadia’s North Carolina facilities where she worked. In contrast, she failed to allege with sufficient particularity that any facilities outside of North Carolina were falsifying therapy notes­ — her mere allegation that a corporate-wide policy existed, without more, was insufficient.

United States ex rel. Gentry v. Encompass Health Rehab. Hosp. of Pearland, L.L.C., 157 F.4th 758 (5th Cir. 2025). Gentry alleged physicians admitted patients to inpatient-rehabilitation facilities (“IRFs”) by rubberstamping the non-clinical judgment of sales representatives, in violation of CMS’ requirement that clinicians exercise their medical judgment in making admission decisions. The court found that Gentry’s allegations were facially benign because Medicare allowed nonclinical personnel to gather data for IRF preadmission screenings, so long as a clinician evaluates the information and makes the final admission decision. Gentry’s inference that the physicians did not evaluate the screening information was based on timing alone, and was speculative at best. Also, her conclusory allegation about Medicare billing lacked the particularity required to infer submission of false claims.

United States ex rel. VIB Partners v. LHC Grp., Inc., No. 24-5393, 2025 U.S. App. LEXIS 9027 (6th Cir. Apr. 14, 2025) (unpublished). The relators alleged that a home healthcare provider submitted false patient data to exaggerate patient needs, thereby inflating Medicare reimbursement rates. The relators argued that their allegations described a systemic scheme of fraud. But the court reasoned that relators cannot survive a Rule 9(b) challenge by alleging a systemic scheme alone, but must also identify at least one false claim submitted to the government.

United States v. Tenet Healthcare Corp., No. 24-1785, 2025 U.S. App. LEXIS 9727 (6th Cir. Apr. 22, 2025) (unpublished). The relators alleged that Tenet and its subsidiary fraudulently billed the government for inpatient care that the patients did not and could not receive. The relators offered representative samples of patients who had inpatient admission orders but were instead held in emergency room facilities and therefore should have been billed as outpatients. The court concluded that each of the relators’ examples described egregious lapses in patient care, but fell short of the specificity pertaining to filing a fraudulent claim for payment required to satisfy Rule 9(b). General policies and practices, as troubling as they may be, cannot satisfy Rule 9(b)’s particularity requirements without further detail.

Childs v. SEIU, No. 23-4334, 2025 U.S. App. LEXIS 15352 (9th Cir. June 23, 2025) (unpublished). The relator challenged the defendants’ use of state-controlled Medicaid funding allocated to trusts intended to benefit home care workers. The court affirmed the dismissal of the relator’s case because he failed to allege that any false “claim” had been submitted to the federal government, as required under the Act. The relator had merely alleged that in certain reports, filed with the government pursuant to federal reporting laws had misrepresented how trust funding was used. Such reports, regardless of their truth or falsity, are not “claims” as they are not requests for money or property from the federal government.

Vargas ex rel. Alvarez v. Lincare, Inc., 134 F.4th 1150 (11th Cir. 2025). The relators alleged systemic upcoding of durable medical equipment, improper kickback arrangement, waiver of co-pays, and shipment of unordered supplies. The relators provided specific allegations to support the upcoding claims, identifying patients, billing codes, and reimbursement amounts. The court found that the relators alleged a scheme, identified specific claims allegedly paid by the government, and explained why the defendant’s coding was improper, therefore dismissal of the upcoding claim was error. But the relators’ remaining claims failed to meet Rule 9(b) particularity standards because they did not identify specific false claims submitted to the government or a link between the alleged schemes and actual claims.

United States ex rel. Plaintiffs v. Atlanta Primary Care Peachtree, PC, No. 23-13845, 2025 U.S. App. LEXIS 16311 (11th Cir. July 2, 2025) (unpublished). The relator’s allegations related to self-referral and kickback schemes involving genetic testing met Rule 9(b)’s particularity requirements because the relator provided details about a representative claim, including the “who, what, where, when, and how” of the allegedly fraudulent scheme. However, her allegations regarding the other schemes failed to meet Rule 9(b)’s requirements because she lacked sufficient details about representative false claims submitted to or paid by the government.

United States v. Quest Diagnostics Inc., No. 24-12998, 2025 U.S. App. LEXIS 17583 (11th Cir. July 16, 2025) (unpublished). The relator provided an exemplar sample of a false claim that she alleged supported liability under multiple theories. The court concluded that no matter which theory she pursued, her complaint rose and fell with the fact that she failed to plead with particularity that a false claim was submitted to the government. The relator had access to the defendant’s billing system and confirmed that the defendant was submitting claims to the government, but failed to provide any specific details regarding either the dates on or the frequency with which the defendants submitted false claims, the amounts of those claims, or the patients whose treatment served as the basis for the claims.

Falsity

The FCA, codified at 31 U.S.C. §§ 3729-33, forbids knowingly submitting a false or fraudulent claim for payment to the government.

United States ex rel. Montcrief v. Peripheral Vascular Assocs., P.A., 133 F.4th 395 (5th Cir. 2025). Peripheral Vascular Associates, P.A. (“PVA”), a vascular surgery practice, utilized technicians to perform ultrasounds, which would then be read and interpreted by a physician. PVA would bill Medicare for both services under a single code. At least some of these “globally” coded claims were submitted before the physician reviewed the ultrasounds. This was therefore a “paradigmatic case” involving “a request for reimbursement for goods or services” that had not yet been furnished, rendering the claims factually false.

United States v. Fillmore Capital Partners, LLC, No. 24-1606, 2025 U.S. App. LEXIS 7502 (3d Cir. Apr. 1, 2025) (unpublished). The relator alleged that the defendant’s nursing home schemed to overbill federal payors by admitting high-acuity residents while understaffing facilities. Nonetheless, the court affirmed that the relator’s claims failed to allege factual falsity on an “inflated claims” theory or a “worthless services” theory because he failed to allege that the nursing home submitted false claims.

Scienter

The FCA imposes liability on anyone who “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” to the federal government. 31 U.S.C. § 3729(a)(1)(A). Either actual knowledge, deliberate ignorance, or recklessness regarding the claim’s falsity will suffice to show scienter. 31 U.S.C. § 3729(b)(1)(A)(i)-(iii).

United States ex rel. Omni Healthcare Inc. v. Md. Spine Sols. LLC, No. 25-1110, 2025 U.S. App. LEXIS 31085 (1st Cir. Dec. 1, 2025) (unpublished). The relator ordered assistants in his seven-office medical practice to order only polymerase chain reaction (“PCR”) urinary tract infection tests from the defendant, even if the ordering physician had specified a less-expensive bacterial urine culture test. The relator then alleged that the defendant knowingly submitted false claims for more expensive PCR tests that were not reasonable and necessary. As a matter of first impression, the court held that in FCA cases alleging Medicare fraud based on laboratory testing, generally a laboratory can rely on a doctor’s order to show that the test is “reasonable and necessary.” Further, the relator failed to rebut this presumption by showing that the defendant knew or should have known the PCR tests were unnecessary.

Materiality

The FCA imposes liability where a person “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)(B). The statute defines “material” as “having 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 misrepresentation about compliance with a statutory, regulatory, or contractual requirement must be material to the government’s payment decision in order to be actionable under the FCA. Universal Health Servs., Inc. v. United States ex rel. Escobar, 579 U.S. 176, 181 (2016).

Bennett v. Bayer Corp., No. 24-1807, 2025 U.S. App. LEXIS 8423 (3d Cir. Apr. 10, 2025) (unpublished). The relator alleged that pharmaceutical companies Bayer Corp. and Johnson and Johnson “had to have known” that certain antibiotics they manufactured caused serious side effects (including neurological and psychiatric damage), but misrepresented information about these side effects to FDA. Specifically, the relator alleged that the defendants disaggregated data, allowing them to report relatively low rates of multiple side effects instead of grouping them together as manifestations of a broader condition. Per the relator, this fraudulently induced FDA to approve the drugs without appropriate warning labels, leading to false claims being submitted to federal payors. The court held that the relator failed to plausibly allege that the data presented was misleading or that the data aggregated as the relator suggested would have led FDA to disapprove the drug or take other action.

United States ex rel. O’Laughlin v. Radiation Therapy Servs., P.S.C., 148 F.4th 791 (6th Cir. 2025). The relator alleged that the defendants fraudulently billed federal programs for radiation services that were not performed by radiation oncologists or radiologists. The court found that the relator did not show that a specific type of physician must perform the radiation services as a material precondition of payment for the claims.

United States ex rel. Streck v. Eli Lilly & Co., 152 F.4th 816 (7th Cir. 2025). The court upheld a $183 million jury verdict against Lilly regarding a relator’s allegations that the company knowingly miscalculated drug rebates owed to Medicaid. Under a deferential standard of review, the court concluded that because Lilly deprived the government of over $60 million in rebates while amassing over $600 million in revenue from subsequent price increases during the relevant period, the jury reasonably concluded the false prices reported to the government were material.

United States ex rel. Wheeler v. Acadia Healthcare Co., 127 F.4th 472 (4th Cir. 2025). Wheeler alleged that Acadia falsified therapy notes for group and individual sessions that were never provided for patients of its opioid treatment program (“OTP”). The court observed that OTPs are required to provide adequate substance use disorder counseling in order to obtain authorization to participate in government healthcare programs and remain in compliance. The court concluded that “compliance with federal methadone-assisted treatment regulations is ‘so central’ to Acadia’s methadone-assisted treatment that the government would not have paid the claims had it been aware of the violations.”

Anti-Kickback Statute

The AKS states that “[w]hoever knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person . . . to purchase . . . any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program, shall be guilty of a felony . . . .” Furthermore, “a claim [for payment by a federal healthcare program] that includes items or services resulting from a violation of [the AKS] constitutes a false or fraudulent claim for purposes of” the FCA.

United States v. Regeneron Pharms., Inc., 128 F.4th 324, 2025 U.S. App. LEXIS 3667 (1st Cir. 2025). The government alleged that, in violation of the AKS, Regeneron knowingly induced prescriptions of a drug by covering copayments for certain patients who received the payment, and therefore Medicare claims for the drug as prescribed to those patients “resulted from” an AKS violation, whether or not those claim would have been made had Regeneron not covered the co-pay. The government urged the United States Court of Appeals for the First Circuit to adopt the causation standard espoused by the Third Circuit — that is, that “resulting from” merely requires some connection between kickbacks and claims. The First Circuit disagreed. Joining the Sixth and Eighth Circuits, the First Circuit held that the phrase “resulting from” in the AKS imposes a requirement of but-for causation to treat an AKS violation as a false or fraudulent claim under the FCA.

United States ex rel. Flanagan v. Fresenius Med. Care Holdings, Inc., 142 F.4th 25 (1st Cir. 2025). Relator Martin Flanagan, a former Fresenius employee, alleged that Fresenius created a kickback scheme to wrongfully induce referrals to its dialysis services. Fresenius allegedly contracted with hospital nephrologists who were in positions to refer high numbers of patients to Fresenius to serve as medical directors at Fresenius outpatient facilities, often paying them more than twice the salary as paid by Fresenius’s primary competitor in the same localities. Flanagan argued that he adequately pled but-for causation by articulating specific compensation relationships with specific physicians that were intended to and did result in referrals. Flanagan provided details about a particular physician who held two medical director positions with Fresenius, including the number of patients the physicians referred, and an internal Fresenius report describing the physician’s dominant role in providing referrals and stating that his contract renewal was critical. But the court concluded that these allegations did not indicate that the physician’s referrals resulted from the alleged kickback scheme, or would not have been made had the physician not been given the medical director positions.

United States ex rel. Sisselman v. Zocdoc, Inc., No. 24-2807, 2025 U.S. App. LEXIS 8719 (2d Cir. Apr. 14, 2025) (unpublished). The relator alleged that Zocdoc’s “booking fee” for each new patient appointment booked through its platform violated the AKS, as the fee was calculated on the estimated annual reimbursement value of the referral to the provider’s medical specialty, as opposed to fair market value. The Office of Inspector General of the Department of Health and Human Services’ (“OIG”) had issued two advisory opinions (“AOs”) to Zocdoc, concluding that Zocdoc’s practices implicated the AKS but did not violate it. The relator’s complaint failed because he did little more than apply conclusory labels to the exact practices and fees discussed by the OIG. The relator also did not plausibly allege that Zocdoc misled the OIG, implemented its fees in a manner inconsistent with either AO, or acted with the scienter required by the FCA and the AKS.

Reverse False Claims

A reverse false claim flips the typical claim under the False Claims Act: “Direct false claims cause the United States to remit money directly to claimants, whereas reverse false claims facilitate the improper withholding of money or property to which the United States is legally entitled.” United States ex rel. Wheeler v. Acadia Healthcare Co., 127 F.4th 472, 495 (4th Cir. 2025); 31 U.S.C. § 3729(a)(1)(G). In its first reverse false claim case since the FCA was amended in 2009, the Wheeler court held that the relator adequately pled her reverse false claim because the stipulated penalties in Acadia’s corporate integrity agreement (“CIA”) with the government would constitute an “obligation” under the FCA. The obligation accrued automatically upon Acadia’s alleged breach of the CIA, even though the government’s enforcement of the CIA was discretionary. The relator sufficiently alleged that the CIA’s penalties had accrued and were knowingly and improperly avoided.

Retaliation

Under 31 U.S.C. §3730(h), an employer cannot retaliate against an individual in any matter “because of lawful acts done by the employee . . . in furtherance of an [FCA enforcement] action under this section or other efforts to stop 1 or more violations” of the FCA.

Morgan-Lee v. Therapy Res. Mgmt., LLC, 129 F.4th 93 (1st Cir. 2025). The court held that 2009 FCA amendments did not undercut the court’s prior precedent that “where an employee’s job responsibilities involve overseeing government billings or payments, h[er] burden of proving that h[er] employer was on notice that [s]he was engaged in protected conduct should be heightened.” In such cases, employees should clearly show that their actions “go beyond their regular duties” so employers are only held accountable for adverse actions when aware of protected conduct. The First Circuit further affirmed that FCA retaliation claims require proof that protected activity was a but-for cause of termination.

Lewis v. AbbVie Inc., 152 F.4th 807 (7th Cir. 2025). The relator alleged that AbbVie promoted a drug for off-label use, and that he had complained to supervisors and HR regarding noncompliance regarding off-label marketing. The court observed that the relator never suggested he feared AbbVie was defrauding the government, and affirmed dismissal of the relator’s FCA retaliation claim.

United States v. Ala. Psychiatry LLC, No. 24-12266, 2025 U.S. App. LEXIS 30132 (11th Cir. Nov. 18, 2025) (unpublished). The relator alleged that, while working for the defendant, he told a probate judge that he believed that the defendant was defrauding patients, Medicare, and Medicaid. The judge relayed the relator’s concerns to the relevant medical centers and the county district attorney. The relator gave the defendant 120 days’ notice of his resignation one week after his report to the probate judge. The defendant then compiled various complaints it had received about the relator and placed him on a performance improvement plan. About two months after the relator’s resignation notice, the defendant hired his replacement and terminated the relator. The court found that the defendant provided legitimate, non-discriminatory reasons for terminating the relator early: (1) it had hired the relator’s replacement based on his resignation letter, and it was uneconomical to keep both; and (2) it had received complaints about his performance. The relator failed to demonstrate “weaknesses, implausibilities, inconsistencies, incoherencies, or contradictions” in the proffered reasons such that a reasonable factfinder would find them unworthy of credence.