United States ex rel. Liesa Kyer v. Thomas Health System, Inc.

Circuit 4Jun 4, 2026

Split Score

SplitScore: 56/100

Case Summary

Disposition

Affirmed

The Fourth Circuit affirmed the dismissal of whistle-blower Liesa Kyer’s False Claims Act suit against Thomas Health System and related entities. The court held that the 83-page complaint failed to plead Stark-Law or Anti-Kickback-Statute violations with the particularity required by Rule 9(b) and that the district court did not abuse its discretion in denying post-judgment leave to amend.

View Full Opinion Document (PDF)

Circuit Split Identified

Legal Issue

Whether the phrase “resulting from” in 42 U.S.C. § 1320a-7b(g) (Anti-Kickback Statute) requires but-for causation between the alleged kickback and the False Claims Act submission.

Circuit Positions

Circuit 1Circuit 6Circuit 8

But-for causation required under § 1320a-7b(g).

Circuit 3

Only a causal link (less than but-for causation) is necessary.

Circuit 4(this circuit)

Issue undecided / no position taken in this opinion.

Conflict Summary

Several circuits hold that liability attaches only when the government claim would not have been submitted ‘but for’ the kickback, while at least one circuit permits liability so long as there is a causal ‘link’ between the kickback scheme and the claim. The Fourth Circuit acknowledged the split but expressly declined to choose a side in this opinion.

Parties & Counsel

Parties

Appellant:United States ex rel. Liesa Kyer
Appellee:Thomas Health System, Inc. et al.

Legal Counsel

Appellant:Morgan Verkamp, LLC
Appellee:Hall Render Killian Heath & Lyman, P.C.; Nelson Mullins Riley & Scarborough LLP