USCA11 Case: 20-11624 Date Filed: 04/26/2021 Page: 1 of 18
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`IN THE UNITED STATES COURT OF APPEALS
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`FOR THE ELEVENTH CIRCUIT
`________________________
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`No. 20-11624
`Non-Argument Calendar
`________________________
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`D.C. Docket No. 4:16-cv-00290-WTM-BKE
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`ESTATE OF DEBBIE HELMLY, et al.,
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` Plaintiffs-Appellants,
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`versus
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`BETHANY HOSPICE AND PALLIATIVE CARE OF
`COASTAL GEORGIA, LLC,
`f.k.a. Bethany Hospice of Coastal Georgia, LLC
`(Bethany Coastal),
`BETHANY HOSPICE AND PALLIATIVE CARE, LLC,
`f.k.a. Bethany Hospice, LLC (Bethany Hospice),
`BETHANY BENEVOLENCE FUND, INC.,
`AVA BEST, et al.,
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` Defendants-Appellees.
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`________________________
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`Appeal from the United States District Court
`for the Southern District of Georgia
`________________________
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`(April 26, 2021)
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`IN THE UNITED STATES COURT OF APPEALS
`
`FOR THE ELEVENTH CIRCUIT
`________________________
`
`No. 20-11624
`Non-Argument Calendar
`________________________
`
`D.C. Docket No. 4:16-cv-00290-WTM-BKE
`
`ESTATE OF DEBBIE HELMLY, et al.,
`
`
` Plaintiffs-Appellants,
`
`versus
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`BETHANY HOSPICE AND PALLIATIVE CARE OF
`COASTAL GEORGIA, LLC,
`f.k.a. Bethany Hospice of Coastal Georgia, LLC
`(Bethany Coastal),
`BETHANY HOSPICE AND PALLIATIVE CARE, LLC,
`f.k.a. Bethany Hospice, LLC (Bethany Hospice),
`BETHANY BENEVOLENCE FUND, INC.,
`AVA BEST, et al.,
`
` Defendants-Appellees.
`
`________________________
`
`Appeal from the United States District Court
`for the Southern District of Georgia
`________________________
`
`(April 26, 2021)
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`USCA11 Case: 20-11624 Date Filed: 04/26/2021 Page: 2 of 18
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`Before MARTIN, NEWSOM, and BRANCH, Circuit Judges.
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`PER CURIAM:
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`In this qui tam action, Debbie Helmly and Jolie Johnson (the “Relators”)
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`appeal the dismissal of their complaint. Relators sued Bethany Hospice and
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`Palliative Care, LLC (“Bethany Hospice”) on behalf of the United States and the
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`State of Georgia,1 alleging that Bethany Hospice violated the False Claims Act
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`(“FCA”), 31 U.S.C. §§ 3729–3733, and the Georgia False Medicaid Claims Act,
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`O.C.G.A. § 49-4-168.1. In particular, Relators alleged that Bethany Hospice
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`violated the so-called Anti-Kickback Statute (“AKS”), 42 U.S.C. § 1320a-7b(b),2
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`by paying physicians remuneration for Medicare and Medicaid patient referrals.
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`According to Relators, Bethany Hospice submitted false claims when it billed the
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`government for services provided to illegally-referred patients. Relators further
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`1 See 31 U.S.C. § 3730(b)(1) (“A person may bring a civil action for a violation of section
`3729 for the person and for the United States Government. The action shall be brought in the
`name of the Government.”); id. § 3732(b) (“The district courts shall have jurisdiction over any
`action brought under the laws of any State for the recovery of funds paid by a State or local
`government if the action arises from the same transaction or occurrence as an action brought
`under section 3730.”).
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` An entity violates the AKS when it:
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` 2
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`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 refer an individual to a person for the
`furnishing or arranging for the furnishing of any item or service for which
`payment may be made in whole or in part under a Federal health care program.
`
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`42 U.S.C. § 1320a-7b(b)(2).
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`2
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`allege that Bethany Hospice falsely certified compliance with the AKS. Under
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`Rule 9 of the Federal Rules of Civil Procedure, Relators were required to plead
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`with particularity the submission of an actual false claim to the government.
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`Because Relators failed to do so, the district court properly dismissed their
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`complaint. Accordingly, we affirm.
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`I. Background3
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`Bethany Hospice provides for-profit hospice care in Georgia. It operates
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`care facilities in four cities: Douglas, Thomasville, Waycross, and Valdosta. In
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`2014, Bethany Hospice opened Bethany Hospice and Palliative Care of Coastal
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`Georgia, LLC (“Bethany Coastal”). Relators are former employees of Bethany
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`Coastal. Helmly was employed as the administrator of Bethany Coastal from
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`December 2014 until July 2015. Johnson was employed as a marketer during the
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`same period.
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`Although Bethany Coastal was organized as a separate company from
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`Bethany Hospice and obtained a different business license number, the two entities
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`are both owned and operated by Ava Best and Mac Mackey and share personnel,
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`resources, and management software. According to Relators, Best and Mackey
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`operated Bethany Coastal “as if it were another facility office of Bethany
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`3 Relators’ original complaint was filed under seal. After the United States and the State
`of Georgia declined to intervene, the complaint was unsealed. The following facts are taken
`from Relators’ third amended complaint (the “operative complaint”).
`3
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`Hospice.” For that reason, Relators allege that they were “effectively . . . corporate
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`insiders of Bethany Hospice.”
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`Relators allege that, as corporate insiders, they learned that Bethany Hospice
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`operated an illegal kickback referral scheme in which Bethany Hospice paid
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`doctors in exchange for referring Medicare beneficiaries4 to Bethany Hospice.
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`Relators further allege that, after rendering services to the illegally referred
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`patients, Bethany Hospice submitted claims to Medicare for reimbursement.
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`In particular, Helmly alleged that when she and Best were negotiating the
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`terms of Helmly’s employment as administrator of Bethany Coastal, Best offered
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`her compensation based on the kickback scheme. During those negotiations, Best
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`allegedly told Helmly that Best “would follow the same protocol to add
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`compensation for . . . Helmly that [Best] used to pay referring doctors for their
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`referrals.” Under that “protocol,” Helmly could make a below-market ownership
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`investment in Bethany Coastal that would provide “huge returns” based on the
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`number of referred patients. Helmly further alleged that Best said that she “paid all
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`the medical directors who owned shares in Bethany Hospice according to this same
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`formula, and the payments varied depending on the volume of referrals.”
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`4 Relators allege that the referral scheme involved Medicare and Medicaid beneficiaries.
`For simplicity, we will refer only to Medicare.
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`4
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`Relators also alleged that, on other occasions, Best acknowledged to them
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`that the compensation structure was designed to avoid getting caught for FCA
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`violations. Best was formerly employed by Odyssey Hospice—a predecessor to
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`Bethany Hospice. Relators alleged that Odyssey also employed a kickback
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`compensation scheme, Odyssey’s owner was eventually convicted of Medicare
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`Fraud, and Odyssey agreed to a $25 million settlement with the U.S. Department
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`of Justice. According to Relators, Best acknowledged that kickbacks were
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`improper but, because they were “the most effective way to get referrals,” Best
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`“tried to have the best of both worlds: paying the kickbacks to referring physicians
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`but hiding or masking them as compensation to medical directors and part owners
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`of Bethany Hospice.”
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`Relators alleged that several doctors purchased ownership interests in
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`Bethany Hospice and were paid kickbacks for referrals through “a monthly salary,
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`dividends, and/or monthly bonuses.”5 According to Relators, that compensation
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`was not paid for the fair market value of their work but, rather, “as inducement for
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`or reward for referrals of patients, which constitute kickbacks.” Relators’
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`complaint points to Dr. Tanner as an example: In 2007, he purchased a 5% interest
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`in Bethany Hospice for $20,000 and, seven years later, he sold that interest for
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`5 Relators also allege that, on at least one occasion, Bethany Hospice offered its doctors a
`paid family vacation as a kickback.
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`5
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`$300,000. Relators’ complaint identifies at least four other doctors (the “Bethany
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`Hospice doctors”) who are allegedly the primary participants in this compensation
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`scheme.
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`Relators point to other facts to show that the scheme was operational and
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`successful. They allege that, after purchasing an investment in Bethany Hospice,
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`the Bethany Hospice doctors made “nearly all” or “around 95%” of their patient
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`referrals to Bethany Hospice. Realtors also allege that they were able to access
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`Bethany Hospice’s internal billing software, Consolo, to confirm that Bethany
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`Hospice tracked each patient admission and the doctor who referred that patient for
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`the purpose of paying those doctors kickbacks. Relators claim that other Bethany
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`Hospice employees confirmed that Bethany Hospice ran “weekly and monthly
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`reports” tracking referrals and that “Best use[d] these reports to determine how
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`much to pay referral sources.”
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`Relators further alleged that, as a result of the kickback scheme, Bethany
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`Hospice submitted false claims for Medicare reimbursement to the government.
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`Relators alleged that “all or nearly all of Bethany Hospice’s patients put under
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`service received coverage from Medicare.” Johnson “had access to the census
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`reports documenting each site’s patients and which payor paid for the patients’
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`care.” By accessing these records, and speaking to some of Bethany Hospice’s
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`billing employees, Johnson allegedly “was able to find out about the billing and
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`6
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`collection from Medicare of the illicit referrals and the submission of bills for other
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`inappropriate patients.” For her part, Helmly alleged that she also had access to all
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`billing information and “attended meetings with Ms. Best where Bethany Hospice
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`and Bethany Coastal management discussed site productivity and census numbers
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`for all Bethany Hospice’s and Bethany Coastal’s sites.” And, relevant here,
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`Relators claim to have discovered that “all (or nearly all) the hospice patients
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`referred by [the Bethany Hospice doctors] were Medicare or Medicaid patients and
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`that Bethany Hospice submitted claims to the Government for per diem payments
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`for those patients knowing that they were false.”
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`Relators’ complaint included government Medicare claims data that showed
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`that “Bethany Hospice derive[d] nearly all of its revenue from the Medicare
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`program monies,” and it provided a breakdown of Medicare referrals from the
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`Bethany Hospice doctors.
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`Finally, Relators alleged that five other Bethany Hospice employees
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`confirmed that Bethany Hospice submitted Medicare reimbursement claims for
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`patients referred by the Bethany Hospice doctors. At bottom, Relators alleged that
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`“all or nearly all” of Bethany Hospice’s business was derived from Medicare
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`beneficiaries and that Bethany Hospice submitted claims for Medicare
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`reimbursement for those patients. Combined with Relators’ access to the billing
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`systems and confirmation from other employees that Bethany Hospice submitted
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`7
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`Medicare reimbursement claims, Relators alleged that Bethany Hospice submitted
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`false claims to the government.
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`As noted, Relators’ operative complaint alleged two causes of action.
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`Relators alleged that Bethany Hospice made false or fraudulent claims for
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`reimbursement based on illegal kickbacks, in violation of 31 U.S.C.
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`§ 3729(a)(1)(A) and O.C.G.A. § 49-4-168.1(a)(1). Relators also alleged that
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`Bethany Hospice made false statements by certifying compliance with the AKS, in
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`violation of 31 U.S.C. § 3729(a)(1)(B) and O.C.G.A. § 49-4-168.1(a)(2).6
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`Bethany Hospice eventually moved to dismiss the operative complaint.
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`Bethany Hospice argued that Relators’ complaint contained primarily conclusory
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`assertions and failed to plead its claims with sufficient particularity, as required by
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`Fed. R. Civ. P. 9(b). The Relators opposed the motion, arguing that the operative
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`complaint satisfied the requirements of Rule 9(b).
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`The district court granted Bethany Hospice’s motion to dismiss with
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`prejudice. First, the district court concluded that Relators did not plead sufficiently
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`particular facts to allege that Bethany Hospice violated the AKS. Although it
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`acknowledged that the Relators had put forth some facts to support their
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`allegations about a kickback scheme, the district court determined that Relators
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`6 Relators also alleged that Best and Bethany Hospice retaliated against them for their
`investigations into the alleged FCA violations, in violation of 31 U.S.C. § 3730(h) and O.C.G.A.
`§ 49-4-168.4. The parties agreed to settle that claim.
`8
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`failed to allege particular facts about the precise nature of the kickback incentives
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`and how much Best paid for referrals. The district court then noted that, despite
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`Relators’ access to billing reports, they failed to “provide specific dates that
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`Bethany Hospice paid doctors, the amounts doctors were paid, or any specific
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`patient in the reports.” The district court added that Relators failed to provide
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`enough background for the district court to infer that Dr. Tanner’s ownership
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`shares were so inflated as to constitute remuneration. Finally, the district court
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`concluded that Relators’ claim that 95% of Bethany Hospice’s referrals came from
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`the Bethany Hospice doctors lacked factual support.
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`Second, the district court concluded that the Relators failed to plead the
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`submission of a false claim with particularity. The district court began by
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`observing that Relators’ complaint did not present an example of a Medicare
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`reimbursement claim that Bethany Hospice submitted to the government on behalf
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`of an illegally referred patient. Next, the district court addressed the Relators’
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`argument that their inside knowledge and Bethany Hospice’s Medicare referral
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`rates were sufficient indicia of reliability to meet Rule 9(b)’s pleading standard.
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`Relying on our FCA precedent, the district court concluded that Relators’
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`complaint lacked sufficient indicia of reliability because Relators: (1) failed to
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`describe Bethany Hospice’s billing operations in sufficient detail, (2) failed to
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`describe a single example of when Relators observed a false claim being
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`9
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`submitted, (3) did not themselves participate in the submission of false claims.
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`Lastly, the district court explained that, under our precedent, courts may not rely
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`on mathematical probability to conclude that a defendant submitted a false claim.
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`Finally, the district court dismissed Relators’ false statements claim. The
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`district court noted that Relators’ complaint contained only one paragraph
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`describing the allegedly false statements. In the district court’s view, that lone
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`paragraph lacked the factual support necessary to plead the claim with sufficient
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`particularity.
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`Relators timely appealed.
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`II. Standard of Review
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`“We review a dismissal with prejudice for failure to state a claim under the
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`False Claims Act de novo.” Urquilla-Diaz v. Kaplan Univ., 780 F.3d 1039, 1050
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`(11th Cir. 2015). We take the allegations in the complaint as true and draw all
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`reasonable inferences in Relators’ favor. Id.
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`III. Discussion
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`Relators argue that the district court erred when it concluded that their
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`complaint failed to plead with particularity Bethany Hospice’s kickback scheme,
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`submission of a false claim, and certification of a false statement. We agree with
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`the district court that Relators failed to plead with particularity the submission of
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`10
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`an actual false claim, and that shortcoming is fatal to Relators’ case. Accordingly,
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`we affirm the district court’s dismissal of Relators’ complaint.
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`“The FCA imposes liability on any person who ‘knowingly presents, or
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`causes to be presented, a false or fraudulent claim for payment or approval; [or]
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`knowingly makes, uses, or causes to be made or used, a false record or statement
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`material to a false or fraudulent claim.’” United States ex rel. Phalp v. Lincare
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`Holdings, Inc., 857 F.3d 1148, 1154 (11th Cir. 2017) (quoting 31 U.S.C.
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`§ 3729(a)(1)(A)–(B)). The AKS “makes it a felony to offer kickbacks or other
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`payments in exchange for referring patients ‘for the furnishing of any item or
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`service for which payment may be made in whole or in part under a Federal health
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`care program.’” McNutt ex rel. United States v. Haleyville Med. Supplies, Inc.,
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`423 F.3d 1256, 1259 (11th Cir. 2005) (quoting 42 U.S.C. § 1320a-b7(b)(1)). And,
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`relevant here, “a claim that includes items or services resulting from a violation of
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`[the AKS] constitutes a false or fraudulent claim for purposes of [§ 3729(a)(1)].”
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`42 U.S.C. § 1320a-7b(g).
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`Nevertheless, the FCA “does not create liability merely for a health care
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`provider’s disregard of Government regulations or improper internal policies
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`unless, as a result of such acts, the provider knowingly asks the Government to pay
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`amounts it does not owe.” United States ex rel. Clausen v. Lab. Corp. of Am., 290
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`F.3d 1301, 1311 (11th Cir. 2002). A violation of the AKS is a separate criminal
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`11
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`offense. See United States v. Sosa, 777 F.3d 1279, 1293 (11th Cir. 2015). But a
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`relator in a qui tam action must plead that a defendant “both violated the [AKS]
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`when it unlawfully recruited a patient and then billed the government for the
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`services provided to that patient.” Carrel v. AIDS Healthcare Found., Inc., 898
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`F.3d 1267, 1277 (11th Cir. 2018). Thus, the “act of submitting a fraudulent claim
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`to the government is the ‘sine qua non of a False Claims Act violation.’” Corsello
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`v. Lincare, Inc., 428 F.3d 1008, 1012 (11th Cir. 2005) (quoting Clausen, 290 F.3d
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`at 1311). Put differently, “[l]iability under the False Claims Act arises from the
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`submission of a fraudulent claim to the government, not the disregard of
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`government regulations or failure to maintain proper internal policies.” Id.
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`Furthermore, complaints alleging violations of the FCA must meet the
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`heightened pleading standard of Rule 9(b). Id.; United States ex rel. Atkins v.
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`McInteer, 470 F.3d 1350, 1357 (11th Cir. 2006). Under Rule 9(b), a party
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`“alleging fraud or mistake . . . must state with particularity the circumstances
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`constituting fraud or mistake.” Fed. R. Civ. P. 9(b). To meet this standard, we
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`have explained that a complaint “must allege actual ‘submission of a false claim,’”
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`and that it must do so with “some indicia of reliability.” Carrel, 898 F.3d at 1275
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`(quoting Clausen, 290 F.3d at 1311) (alteration adopted). It is not enough to “point
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`to ‘improper practices of the defendant’ to support ‘the inference that fraudulent
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`claims were submitted’ because ‘submission . . . cannot be inferred from the
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`12
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`circumstances.’” Id. (quoting Corsello, 428 F.3d at 1013) (alterations adopted). In
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`short, a relator must “allege the ‘who,’ ‘what,’ ‘where,’ ‘when,’ and ‘how’ of
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`fraudulent submissions to the government.” Corsello, 428 F.3d at 1014.
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`Although Relators concede that their complaint did not include any details
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`about specific claims submitted to the government, they argue that they have met
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`Rule 9(b)’s pleading threshold because their complaint contains sufficient indicia
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`of reliability to support their claim that Bethany Hospice submitted false claims to
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`the government. First, Relators rely on their complaint’s allegations that they had
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`access to and knowledge of Bethany Hospice’s billing practices. For example,
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`Relators alleged that they attended meetings in which Best “discussed site
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`productivity and census numbers for all Bethany Hospice’s and Bethany Coastal’s
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`sites.” Relators further alleged that they reviewed billing data that showed that
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`Bethany Hospice submitted Medicare reimbursement claims for patients referred
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`by the Bethany Hospice doctors. And Relators alleged that five other Bethany
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`Hospice employees confirmed that such claims were submitted. Second, Relators
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`draw our attention to the numbers. They alleged that the Bethany Hospice doctors
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`referred significant numbers of Medicare recipients to Bethany Hospice and that
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`“all or nearly all” of Bethany Hospice’s patients received coverage from Medicare.
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`In short, Relators argue that their knowledge and access, coupled with data about
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`13
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`Bethany Hospice’s Medicare claims submissions, lends sufficient indicia of
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`reliability to survive Bethany Hospice’s motion to dismiss. We disagree.
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`To begin, Relators have failed to allege any specifics about actual claims
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`submitted to the government. Despite alleging intimate familiarity with and access
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`to Bethany Hospice’s billing practices, Relators’ complaint fails to identify even a
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`single, concrete example of a false claim submitted to the government. See
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`Clausen, 290 F.3d at 1306 (“[N]o copies of a single actual bill or claim or payment
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`were provided. No amounts of any charges by LabCorp were identified. No actual
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`dates of claims were alleged. Not a single completed Form 1500 was provided.”);
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`Carrel, 898 F.3d at 1277 (noting that the plaintiff failed to allege facts about a
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`specific claim submitted for reimbursement).
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`To be sure, we do not always require a sample fraudulent claim because “we
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`are more tolerant toward complaints that leave out some particularities of the
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`submissions of a false claim if the complaint also alleges personal knowledge or
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`participation in the fraudulent conduct.” United States ex rel. Matheny v. Medco
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`Health Sols., Inc., 671 F.3d 1217, 1230 (11th Cir. 2012). But Relators do not even
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`attempt to provide any particular facts about a representative false claim.
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`Moreover, Relators do not have the personal knowledge or level of participation
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`that can give rise to some indicia of reliability. In Carrel, the relators “highlighted
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`their managerial positions” at the defendant company and their attendance “at
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`monthly financial review meetings.” 898 F.3d at 1277. But we found this kind of
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`senior insider knowledge insufficient because “the relators failed to explain how
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`their access to possibly relevant information translated to knowledge of actual
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`tainted claims presented to the government.” Id. at 1278. Relators’ complaint
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`suffers from the same flaw. The complaint alleged that at least one Relator
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`(Helmly) attended meetings that discussed the productivity of various Bethany
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`Hospice sites and that both Relators had access to Bethany Hospice’s billing
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`systems and confirmed from their review of those systems and conversations with
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`other employees that Bethany Hospice submitted false claims. Those allegations
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`are insufficient to satisfy Rule 9(b)’s particularity requirement because even with
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`“direct knowledge of the defendants’ billing and patient records,” Relators have
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`“failed to provide any specific details regarding either the dates on or the frequency
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`with which the defendants submitted false claims, the amounts of those claims, or
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`the patients whose treatment served as the basis for the claims.” United States ex
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`rel. Sanchez v. Lymphatx, Inc., 596 F.3d 1300, 1302 (11th Cir. 2010).
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`Additionally, Relators did not claim to have observed the submission of an actual
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`false claim; nor did they personally participate in the submission of false claims.
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`See Matheny, 671 F.3d at 1230 (crediting the complaint’s allegations when one of
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`the relators was intimately involved in a department of the defendant company that
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`was responsible for creating the alleged false claims.); United States v. R&F Props.
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`15
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`of Lake Cnty., Inc., 433 F.3d 1349, 1356–58 (11th Cir. 2005) (crediting a
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`complaint’s allegations because one of the relators was a nurse practitioner who
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`personally used incorrect billing codes). In sum, Relators’ access and knowledge
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`are not sufficient indicia of reliability.
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`Relators’ reliance on Bethany Hospice’s business model and Medicare
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`claims data lends no credence to their allegation that Bethany Hospice submitted a
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`false claim. Relators alleged that Bethany Hospice doctors referred significant
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`numbers of Medicare recipients, that “all or nearly all” of Bethany Hospice’s
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`patients were Medicare recipients, and that Medicare claims data shows that
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`Bethany Hospice billed the government for their patients. Therefore, Relators
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`contend, their complaint contains sufficient indicia of reliability to allege plausibly
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`that Bethany Hospice submitted a false claim. But we have explained that relators
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`cannot “rely on mathematical probability to conclude that [a defendant] surely
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`must have submitted a false claim at some point.” Carrel, 898 F.3d at 1277; see
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`also Corsello, 428 F.3d at 1012–13 (explaining that it is insufficient to “describe[]
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`in detail a private scheme to defraud” and then speculate that claims “must have
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`been submitted, were likely submitted or should have been submitted to the
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`Government”). Thus, numerical probability is not an indicium of reliability.
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`Relators attempt to distinguish Clausen and Carrel by pointing out that neither
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`defendant in those cases billed the government for almost all its business. That
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`
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`16
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`USCA11 Case: 20-11624 Date Filed: 04/26/2021 Page: 17 of 18
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`distinction is unpersuasive. Under the FCA and Rule 9(b), a false claim cannot be
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`“inferred from the circumstances.” Corsello, 428 F.3d at 1013. Whether a
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`defendant bills the government for some or most of its services, the burden remains
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`on a relator alleging the submission of a false claim to “allege ‘specific details’
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`about false claims to establish ‘the indicia of reliability necessary under Rule
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`9(b).’” Carrel, 898 F.3d at 1276 (quoting Sanchez, 596 F.3d at 1302). Here,
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`Relators have failed to allege any specific details about the submission of an actual
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`false claim.7
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`In sum, Relators’ complaint fails to contain some indicia of reliability to
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`meet Rule 9(b)’s particularity requirement. Although we construe all facts in favor
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`of Relators, we “decline to make inferences about the submission of fraudulent
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`claims because such an assumption would ‘strip[] all meaning from Rule 9(b)’s
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`requirements of specificity.’” Corsello, 428 F.3d at 1013 (quoting Clausen, 290
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`F.3d at 1312 n.21); Atkins, 470 F.3d at 1359 (“The particularity requirement of
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`Rule 9 is a nullity if Plaintiff gets a ticket to the discovery process without
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`identifying a single claim.” (quotation omitted)); id. at 1360 (“Requiring relators to
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`
`7 Relators also rely on two other decisions that they argue support their case. See United
`States ex rel. Mastej v. Health Mgmt. Assocs., Inc., 591 F. App’x 693, 695 (11th Cir. 2014); Hill
`v. Morehouse Med. Assocs., 2003 WL 22019936, at *3–4 (11th Cir. Aug. 15, 2003) (per curiam).
`We do not read those nonprecedential decisions to be contrary to our analysis.
`17
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`USCA11 Case: 20-11624 Date Filed: 04/26/2021 Page: 18 of 18
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`plead FCA claims with particularity is especially important in light of the quasi-
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`criminal nature of FCA violations (i.e., a violator is liable for treble damages).”).
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`Because Relators have failed to plead the submission of an actual false claim
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`with particularity, their false statement claim also fails. The “submission of a
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`[false] claim is . . . the sine qua non of a False Claims Act violation.” Clausen,
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`290 F.3d at 1311. And as Relators acknowledge, “[i]f Bethany Hospice’s claims
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`were false or fraudulent, it follows that when Bethany Hospice certified its
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`compliance with the AKS” it made false statements under § 3729(a)(1)(B). But
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`Relators have failed to plead a false claim with particularity, so their false
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`statement claim must also be dismissed. See, e.g., United States ex rel. Grant v.
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`United Airlines Inc., 912 F.3d 190, 199–200 (4th Cir. 2018) (dismissing a false
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`statement claim because relators’ complaint failed to allege a false claim); United
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`States ex rel. Strubbe v. Crawford Cnty. Mem’l Hosp., 915 F.3d 1158, 1166 (8th
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`Cir. 2019) (rejecting a false statement claim because the complaint “fail[ed] to
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`connect the false records or statements to any claim made to the government”).
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`IV. Conclusion
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`Because Relators failed to allege the submission of an actual false claim
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`with particularity, the district court properly dismissed their complaint.
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`Accordingly, we affirm.
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`AFFIRMED.
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