Facts

Plaintiff James Swoben, a former employee of previously dismissed defendant SCAN, brought a third amended complaint directed at several insurers and a medical group. Swoben alleged that defendants submitted inaccurate data for payment of health care claims.

Defendants moved to dismiss the complaint on the grounds that the relator failed to state a claim and on the grounds that the third amended complaint failed to meet the pleading requirements of Fed R. Civ P. 9 because it contained no details of the allegedly false claims submitted for payment.

PLAINTIFF'S CONTENTIONS:
Swoben claimed that the health maintenance organization defendants and Healthcare Partners violated the False Claims Act and defrauded Medicare Advantage by committing auditing fraud, which involved unlawfully designed and retrospective reviews, which caused Medicare overpayments.

In a third amended complaint, Swoben alleged a claim for relief for violation of 31 U.S.C. Section 3729(a) against the UnitedHealth defendant; a claim for relief for violation of California Government Code Section 12651(a) against the UnitedHealth defendants; a claim for relief for violation of 31 U.S.C. Section 3729(a) against the UnitedHealth defendants, Health Net, Aetna, WellPoint, and HealthCare Partners; and a claim for relief for violation of California Government Code Section12651(a) against the UnitedHealth defendants, Health Net, Aetna, WellPoint, and HealthCare.

DEFENDANT'S CONTENTIONS:
Defendants argued that plaintiff's claims failed because they were based on publicly available information.

Result

The court dismissed the third amended complaint with prejudice after having determined that plaintiff's proposed fourth amended complaint would not cure the defects evident in his third amended complaint.