United States of America ex re. Bonnie Sterling v. Health Insurance Plan of Greater New York 06 Civ. 1141 (PAC)

Ms. Sterling, the relator, alleged that HIP violated the False Claims Act by falsifying data to obtain NCQA accreditation that the U.S. Office of Personnel Management relied on to issue contracts. The Court granted HIP's motion to dismiss the complaint for failure to state a claim and failure to plead fraud with particularity.

The Court relied in part on the recent Allison Engine Supreme Court decision. The Court considered whether HIP made false statements to NCQA with the intent that the Government would rely on the statements as a condition of payment. The Court concluded that there was no evidence to support that allegation.

In addition, the plaintiff alleged that the presentment of an alleged false claim to NCQA serves as a presentment of a claim to the Government. The Court disagreed—there was no presentment of a claim to the Government, particularly when NCQA is "not funded by, in contract with, or related to the government in any way."