[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________ FILED
U.S. COURT OF APPEALS
No. 09-14275 ELEVENTH CIRCUIT
FEBRUARY 18, 2010
Non-Argument Calendar
JOHN LEY
________________________
CLERK
D. C. Docket No. 07-80900-CV-DMM
UNITED STATES OF AMERICA,
ex rel. Laika Sanchez,
Plaintiff,
LAIKA SANCHEZ,
Plaintiff-Appellant,
versus
LYMPHATX, INC.,
PAMELA COHEN,
JACOB COHEN,
Defendants-Appellees,
LYMPHATICS PLUS OF BOCA
RATON, INC., etc.
Defendant.
________________________
Appeal from the United States District Court
for the Southern District of Florida
_________________________
(February 18, 2010)
Before CARNES, MARCUS and KRAVITCH, Circuit Judges.
PER CURIAM:
Laika Sanchez appeals from the district court’s order dismissing her qui tam
complaint on behalf of the United States against Lymphatx and its owners for
violations of the False Claims Act, 31 U.S.C. §§ 3729–30.1 The district court
concluded that Sanchez had failed to plead her allegations of fraud with the
particularity required by Federal Rule of Civil Procedure 9(b) and that she had
failed to state a claim for retaliation under 31 U.S.C. § 3730(h). Sanchez argues
that the district court erred in dismissing her complaint for failure to state a claim,
see Fed. R. Civ. P. 12(b)(6), and in closing her case without granting her leave to
amend. Having carefully reviewed the record in this case, we affirm in part,
reverse in part, and remand.
1
Title 31, Section 3730(b) of the U.S. Code empowers private persons (“relators”) to sue
in the name of the government when it has suffered fraud.
2
After the United States declined to intervene in her qui tam action, Sanchez
served an amended complaint on Lymphatx, her former employer, and its owners.
The complaint asserted five claims for relief under the False Claims Act. Four of
the claims depended on Sanchez’s allegations of the defendants’ fraudulent
Medicare-billing practices under § 3729. The fifth claim, under § 3730(h), was
that Sanchez had been fired in retaliation for her complaints to Lymphatx’s owners
about the illegality of those practices. We review the district court’s dismissal of
these claims de novo. Corsello v. Lincare, Inc., 428 F.3d 1008, 1012 (11th Cir.
2005).
I. Fraudulent Billing Claims
To state a claim premised on fraud, Sanchez needed to “state with
particularity the circumstances constituting [the] fraud.” Fed. R. Civ. P. 9(b); see
also United States ex rel. Clausen v. Lab. Corp. of Am., 290 F.3d 1301, 1308 (11th
Cir. 2002) (“Rule 9(b) does apply to actions under the False Claims Act.”). In her
complaint, Sanchez alleged that the defendants had knowingly submitted false
claims to Medicare for lymphedema treatments performed by massage therapists.2
2
Lymphedema is swelling caused by impairments in the body’s lymphatic system. One
treatment for the condition involves light massage to encourage the drainage of excess fluid.
Medicare will not pay for this treatment if it is provided by a massage therapist. See 69 Fed. Reg.
66236, 66351 (Nov. 15, 2004) (“Medicare does not, for example, [cover] therapy services
performed by massage therapists . . . .”); Medicare Claims Processing Manual ch. 5 p. 31 (Apr.
24, 2009) (defining manual lymphatic drainage (CPT code 97140) as a “therapy service”).
3
Sanchez further alleged that the defendants had intentionally billed Medicare for
services they did not provide and that she had gained personal knowledge of these
billing practices through her employment as Lymphatx’s office manager.3
In addition to her general accusations of false billing, Sanchez needed to
plead “facts as to time, place, and substance of the defendants’ alleged fraud,
specifically, the details of the defendants’ allegedly fraudulent acts, when they
occurred, and who engaged in them.” Clausen, 290 F.3d at 1310 (quotation marks
and citation omitted). Despite her assertion that she had direct knowledge of the
defendants’ billing and patient records, however, Sanchez 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. Without these or similar
details, Sanchez’s complaint lacks the “indicia of reliability” necessary under Rule
9(b) to support her conclusory allegations of wrongdoing. See Clausen, 290 F.3d
at 1311–12. In other words, because she failed “to allege at least some examples
of actual false claims,” Sanchez could not “lay a complete foundation for the rest
3
The defendants dispute whether Sanchez was, in fact, an office manager, but on our de
novo review of an order dismissing a complaint for failure to state a claim, we assume the truth
of all facts alleged in the complaint. Corsello, 428 F.3d at 1012.
4
of [her] allegations.” Id. at 1314 n.25. The district court therefore appropriately
dismissed the four claims alleging fraudulent billing.4
We reject Sanchez’s argument that the district court should have allowed
her to amend her complaint before dismissing these claims. “A district court is not
required to grant a plaintiff leave to amend his complaint sua sponte when the
plaintiff, who is represented by counsel, never filed a motion to amend []or
requested leave to amend before the district court.” Wagner v. Daewoo Heavy
Indus. Am. Corp., 314 F.3d 541, 542 (11th Cir. 2002) (en banc). Sanchez was
represented by counsel but did not move for leave to amend, and we cannot
conclude that the district court abused its discretion by failing to grant leave that
was never requested. Burger King Corp. v. Weaver, 169 F.3d 1310, 1318 (11th
Cir. 1999).
4
We distinguish this case from United States ex rel. Walker v. R&F Properties of Lake
County, Inc., 433 F.3d 1349, 1360 (11th Cir. 2005), in which we affirmed the denial of a motion
to dismiss a qui tam plaintiff’s complaint. The plaintiff in that case was a nurse practitioner who
alleged a practice of fraudulent Medicare billing by her former employer. Specifically, she
alleged that the defendant’s office administrator had told her that the defendant billed Medicare
at arguably inflated rates. Sanchez’s vague allegations that she “found [unspecified]
documentation” and “discovered” or “learned” that the defendants had submitted false claims, by
contrast, leaves us “wondering whether [she] has offered mere conjecture or a specifically
pleaded allegation on an essential element of the lawsuit,” Clausen, 290 F.3d at 1313. In any
event, to the extent that Walker conflicts with the specificity requirements of Clausen, our prior-
panel-precedent rule requires us to follow Clausen. See Walker v. Mortham, 158 F.3d 1177,
1188–89 (11th Cir. 1998).
5
II. Retaliatory Discharge Claim
With respect to Sanchez’s claim for retaliatory discharge, at the time of her
termination the False Claims Act provided relief to any employee discharged
because of lawful acts taken “in furtherance of an action under this section,
including investigation for, initiation of, testimony for, or assistance in an action
filed or to be filed under this section.” 31 U.S.C. § 3730(h) (2006), amended by
Pub. L. No. 111-21, § 4(d), 123 Stat. 1617, 1624–25 (2009).5 Sanchez argues that
she engaged in conduct protected by § 3730(h) because, as alleged in her
complaint, she “complained again and again about the unlawful actions of the
Defendants” and “told them that they were all incurring significant criminal and
civil liability.” In Childree v. UAP/GA AG Chem., Inc., we held that § 3730(h)
only protected an employee from retaliation when there was at least “a distinct
possibility” of litigation under the False Claims Act at the time of the employee’s
actions. 92 F.3d 1140, 1146 (11th Cir. 1996).6 The question here, then, is whether
5
Congress’s recent amendment provides relief to any employee discharged for acting “in
furtherance of other efforts to stop 1 or more violations of this subchapter.” Pub. L. No. 111-21,
§ 4(d), 123 Stat. 1617, 1624–25 (2009) (emphasis added). We need not consider the effect of
this change on the viability of Sanchez’s claim because the amendment only applies to conduct
on or after May 20, 2009. See id. § 4(f), 123 Stat. at 1625. Lymphatx fired Sanchez in 2007.
6
Our decision in Childree does not require that this litigation would have ended with the
government recovering from the defendant. Section 3730(h) “protects an employee’s conduct
even if the target of an investigation or action to be filed was innocent.” Graham County Soil &
Water Conservation Dist. v. United States ex rel. Wilson, 545 U.S. 409, 416 (2005).
6
Sanchez’s complaints of illegal activity occurred when there was a distinct
possibility that she or the government would sue the defendants under the False
Claims Act. See id.
The defendants compare Sanchez’s conduct to the sort of internal reporting
that some of our sister circuits have held falls outside the scope of § 3730(h). See,
e.g., McKenzie v. BellSouth Telecomms., Inc., 219 F.3d 508, 516 (6th Cir. 2000)
(“[Section § 3730(h)’s] ‘in furtherance of’ language requires more than merely
reporting wrongdoing to supervisors.”); Zahodnick v. IBM Corp., 135 F.3d 911,
914 (4th Cir. 1997) (“Simply reporting his concern of a mischarging to the
government to his supervisor does not suffice to establish that Zahodnick was
acting ‘in furtherance of’ a qui tam action.”). But those courts have also
recognized that an employee may put her employer on notice of possible False
Claims Act litigation by making internal reports that alert the employer to
fraudulent or illegal conduct. McKenzie, 219 F.3d at 516 (“Although internal
reporting may constitute protected activity, the internal reports must allege fraud
on the government.”); Eberhardt v. Integrated Design & Constr., Inc., 167 F.3d
861, 868 (4th Cir. 1999) (“[C]haracterizing the employer’s conduct as illegal or
fraudulent . . . let[s] the employer know, regardless of whether the employee’s job
duties include investigating potential fraud, that litigation is a reasonable
7
possibility.”). If an employee’s actions, as alleged in the complaint, are sufficient
to support a reasonable conclusion that the employer could have feared being
reported to the government for fraud or sued in a qui tam action by the employee,
then the complaint states a claim for retaliatory discharge under § 3730(h). Cf.
Mann v. Olsten Certified Healthcare Corp., 49 F. Supp. 2d 1307, 1314 (M.D. Ala.
1999) (using a similar standard on consideration of a motion for summary
judgment).
Sanchez’s allegations that she complained about the defendants’ “unlawful
actions” and warned them that they were “incurring significant criminal and civil
liability” would have been sufficient, if proven, to support a reasonable conclusion
that the defendants were aware of the possibility of litigation under the False
Claims Act. Because her retaliation claim did not depend on allegations of fraud,
Sanchez’s complaint only needed “a short and plain statement of the claim
showing that [she was] entitled to relief.” Fed. R. Civ. P. 8(a). We conclude that
she satisfied this requirement and that the district court therefore erred in
dismissing her claim for retaliatory discharge.
III. Conclusion
In light of our conclusion that Sanchez failed to state claims premised on
fraudulent billing but successfully stated a claim for retaliatory discharge under
8
§ 3730(h), we AFFIRM the district court’s order in part, REVERSE in part, and
REMAND for further proceedings consistent with this opinion.
9