Supreme Court of the United States

“ And, as explained above, the FCA’s scienter standards are plainly satisfied by a defendant’s conscious belief that his claims are false.
Second, Safeco did not purport to set forth the purely objective safe harbor that respondents invoke. To the contrary, Safeco stated that a person is reckless if he acts “knowing or having reason to know of facts which would lead a reasonable man to realize” that his actions were substantially risky. ”

“ To illustrate why, consider a hypothetical driver who sees a road sign that says “Drive Only Reasonable Speeds.” That driver, without any more information, might have no way of knowing what speeds are reasonable and what speeds are too fast. ”

“ And here, the FCA’s definition of “knowingly” confirms that assumption by largely tracking the common-law scienter standards for fraud.
On their face and at common law, the FCA’s standards focus primarily on what respondents thought and believed. First, the term “actual knowledge” refers to whether a person is “aware of ” information. ”

“ The difficulty here, however, is that the phrase “usual and customary” is, on its face, less than perfectly clear. We assume (as the District Court ruled in SuperValu’s case) that respondents’ “usual and customary” prices were their discounted ones; if so, it might have been a forgivable mistake if respondents had honestly read the phrase as referring to retail prices, not discounted prices. But the Seventh Circuit did not hold that respondents made an honest mistake ”

“ Petitioners here brought two such lawsuits against respondents, which are companies that operate hundreds of retail drug pharmacies nationwide. In No. 21–1326, respondents are a group of companies that we collectively call SuperValu; in No. 22–111, respondent is Safeway, Inc. According to petitioners, respondents overcharged Medicare and Medicaid programs for years when seeking reimbursement for prescription drugs that the programs covered. ”

“ In doing so, they plainly implied facts about their prices that were not known to the plan sponsors, pharmacy benefit managers, and state Medicaid agencies that received their claims. Petitioners’ cases thus make out a valid fraud theory even under respondents’ common-law rule. ”

“ And, in this context, the scienter requirement of the FCA is plainly directed to the falsity of the claims submitted. §3729 (a) (1) (A) . ↑ In some civil contexts, a defendant may be called “reckless” for acting in the face of an unjustifiably high risk of illegality that was so obvious that it should have been known, even if the defendant was not actually conscious of that risk. ”