Full opinion text
Order GRAY H. MILLER, District Judge. Pending before the court are (1) defendants Solvay America Inc. (“SAI”) and Solvay North America LLC’s (“SNA”) motion to dismiss relators John King and Jane Doe’s (collectively, “Relators”) fourth amended complaint (“4AC”) (Dkt. 121); and (2) defendant Abbott Products Inc.’s, which was formerly known as Solvay Pharmaceuticals Inc. (“SPI”), motion to dismiss Relators’ 4AC (Dkt. 122). Having considered the motions and related documents, including the United States’ statement of interest (Dkt. 130), as well as the applicable law, the court is of the opinion that SAI and SNA’s motion to dismiss (Dkt. 121) should be GRANTED IN PART AND DENIED IN PART, and SPI’s motion to dismiss (Dkt. 122) should be GRANTED IN PART AND DENIED IN PART. I. Background This case is about a pharmaceutical manufacturer and its affiliates that allegedly made millions of dollars by marketing three drugs — Luvox, Aceon, and AndroGel — for conditions other than the conditions for which the drugs were approved by the Food and Drug Administration (“FDA”) and by offering kickbacks to physicians who prescribed the drugs. Dkt. 114. Relators worked for SPI as district sales managers, and they were responsible for supervising sales representatives who marketed AndroGel, Luvox, and Aceon (collectively, the “Drugs at Issue”). Dkt. 114 at 150; Dkt. 122-2 at 1. Relators claim that their employment was terminated after they questioned the ethics and legality of off-label promotions and kickbacks. Dkt. 114 at 150-57. Relators thereafter brought this qui tarn action against Solvay SA, SAI, SPI, SNA, Solvay Pharmaceuticals SARL, and Abbott Products, Inc., on behalf of the federal government and the States of Illinois, California, Colorado, Florida, Tennessee, Texas, Delaware, Nevada, Louisiana, Hawaii, Georgia, Indiana, Michigan, Montana, New Hampshire, New Jersey, New Mexico, Oklahoma, Rhode Island, Wisconsin, and Maryland, the Commonwealths of Massachusetts and Virginia, and the District of Columbia, asserting claims for violations of the federal False Claims Act (“FCA”), as well as various state versions of those statutes. Dkt. 114 at 171-248. Relators also claim that Solvay conspired with physicians to promote off-label uses of the Drugs at Issue in violation of the FCA and to pay kickbacks in violation of the federal Anti-Kickback Statute (“AKS”). Id. at 169. Finally, Relators contend that Solvay retaliated against them in response to their questioning its marketing schemes by first criticizing Relators and eventually terminating their employment. Id. at 166. A. Procedural History On June 10, 2003, Relators filed their original complaint in the Eastern District of Pennsylvania. Dkt. 1. The Relators moved to transfer venue to the Southern District of Texas on June 26, 2006, and the court granted that motion on June 27, 2006. Dkt. 27 (Sealed). Relators filed their first amended complaint on July 15, 2008. Dkt. 38. They filed their second amended complaint on December 7, 2009. Dkt. 54. SAI and SNA filed a motion to dismiss the second amended complaint on March 19, 2010, and SPI filed a motion to dismiss the second amended complaint on the same day. Dkts. 94, 95. Relators moved to amend their complaint, and the court granted that motion and denied the motions to dismiss as moot. Dkts. 99, 102, 104. Relators filed their third amended complaint on September 15, 2010. Dkt. 111. The third amended complaint contains confidential information about physicians who prescribed the Drugs at Issue. Dkts. 112, 113. On September 30, 2010, Relators filed their fourth amended complaint, which is substantially similar to the third amended complaint except that the confidential information has been removed or altered to address the confidentiality concerns. See Dkt. 114. On December 7, 2010, Abbott and SPI filed a motion to dismiss the 4AC in which they assert (1) the alleged violations of section 3729 of the FCA are insufficiently pled under Rules 8(a), 9(b), and 12(b)(6); (2) the alleged violation of section 3730(h) of the FCA is time-barred and fails to allege facts supporting each element of the cause of action; (3) the state qui tam claims in counts 5-33 are insufficient for the same reasons as the FCA claims and for additional state-specific reasons; and (4) count 34 requests “common fund relief’ against states, which is not a cause of action. Dkt. 122-2. On November 30, 2011, SAI and SNA filed a motion to dismiss the 4AC in which they argue that the 4AC (1) fails to allege with particularity the roles of SNA and SAI in the alleged misconduct; and (2) fails to plead any facts showing that SNA or SAI engaged in any misconduct or that they exhibited the total control and dominion of SPI that would be required for Relators to state a claim against SNA and SAI for the alleged misconduct of another corporate entity. Dkt. 121-1. SNA and SAI additionally move for dismissal of the claims against them for all of the reasons asserted in SPI’s motion. Id. Both motions request prejudicial dismissal. Dkts. 121-1,122-2. B. Alleged Off-Label Promotion Relators contend that Solvay inappropriately marketed the Drugs at Issue for off-label use by (1) encouraging its sales representatives to market the drugs to specifically targeted high Medicaid prescribes who Solvay deemed likely to heavily prescribe the drugs; (2) “shaping the science” through medical literature by paying influential doctors to research and write about the off-label uses that provided the most promise of profit; and (3) influencing physician speakers to promote the drugs off label. Id. at 95-107. 1. Luvox Luvox, which is the trade name for fluvoxamine, was initially approved by the FDA in 1994 for the treatment of Obsessive Compulsive Disorder (“OCD”). Id. at 26-27. Luvox CR is an extended release version of Luvox. Id. at 30. In 2007, the FDA approved Luvox for the treatment of Social Anxiety Disorder in adults, and it approved Luvox CR for the treatment of both OCD and Social Anxiety Disorder in 2008. Id. at 30-31. Relators contend that Solvay marketed Luvox for use in treating depression, anxiety-related disorders, and other conditions of what Solvay called the “OC Spectrum,” such as stand alone anxiety disorder, Tourette’s syndrome, antisocial personality- disorder, schizo-obsessive disorder, sexual compulsions, and ADHD, even though Luvox was not approved for the treatment of these conditions. Id. at 31. Relators also contend that Solvay downplayed important risks associated with Luvox, including drug interactions, cardiovascular risks in older patients, and an increased risk of mania in children and adolescents. Id. at 43-47. Relators claim that Luvox was a top-selling drug for defendants, with $6 million in Medicaid claims in Texas alone. Relators point to specific physicians in Texas who prescribed Luvox to patients for off-label use after sales representatives “pitched” these uses during sales calls. Id. at 50 & Exh. 18. 2. Aceon Aceon, which is the trade name for perindopril, is an ACE-inhibitor that was approved by the FDA for the treatment of hypertension (high blood pressure) in 1993. Dkt. 114 at 51. In 2005, the FDA approved the drug for use in treating stable coronary artery disease to reduce the risk of cardiovascular death or myocardial infarction. Id. According to Relators, Solvay promoted Aceon and attempted to distinguish it from numerous ACE inhibitor competitors by claiming, with little or no scientific support, that (1) Aceon delivers a structural change in arteries; (2) Aceon provides 24-hour control with no spikes in blood pressure at the end of the dosing cycle; and (3) Aceon lowers the incidence of secondary strokes. Id. Solvay allegedly advised doctors that Aceon delivered a structural change in arteries, remodeling them, as opposed to merely lowering blood pressure like other ACE inhibitors. Id. at 52. Solvay called this restructuring “arterial wall compliance.” Id. Relators claim that there was no scientific justification for these claims and that nothing in Aceon’s FDA-approved label supports the claims. Id. Solvay also allegedly promoted Aceon by claiming that it provided better blood pressure control than competitors because it did not allow a spike in blood pressure during the latter part of the dosing interval. Id. at 54. Relators claim that no scientific studies support this claim. Id. at 55. Additionally, Solvay allegedly claimed after the completion of the PROGRESS trial that Aceon lowered the incidence of secondary stroke. Id. at 59-60. However, according to Relators, the actual results of the PROGRESS trial indicated that the incidence of secondary strokes was only lowered when a rarely used diuretic, indapamide, was added to Aceon, and that, in fact, there was no indication that Aceon added any synergistic effect to the diuretic. Id. at 59 (citing Exh. 32). Relators contend that these tactics induced “[ujnsuspecting doctors” to prescribe Aceon instead of other, less expensive drugs. Id. at 61. Relators provide specific examples of doctors who (1) wrote prescriptions for Aceon after attending talks about arterial wall compliance; (2) wrote prescriptions for Aceon to patients with diabetes, allegedly due to the campaign indicating that Aceon provides better blood pressure control at the end of the dosing cycle — which would be especially significant for patients with renal dysfunction related to diabetes; and (3) wrote prescriptions for Aceon for patients with cerebrovascular disease after attending a program on the PROGRESS study that discussed the off-label use of Aceon as a stroke preventative. Id. at 63-65. 3. AndroGel AndroGel, which is a synthetic testosterone gel, was approved by the FDA in 2000 as being “ ‘indicated for replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone’ ” — specifically, primary hypogonadism and hypogonadotropic hypogonadism. Id. at 66 (quoting Exh. 39 (original AndroGel label)). According to Relators, Solvay desired a larger audience for the product, so it formed a strategy to mass market the product for “andropause,” which is “a supposed condition of male aging,” and for “related ailments such as osteoporosis, sexual dysfunction (as a Viagra substitute), and depression, in male patients with both normal and abnormal testosterone levels, with and without clinical symptoms.” Id. at 69. Solvay also allegedly marketed the product for the following off-label uses: “ ‘wasting? in HTV and AIDS patients, women, methadone and other opioid users, diabetics, and those •with ‘metabolic syndrome’ (i.e. obese).” Id. Relators present data indicating that specific Texas physicians have prescribed AndroGel for off-label uses, including pediatric use, use in women and HIV/AIDS patients, and andropause and andropause symptoms (including senile depressive disorder, osteoporosis, and sexual dysfunction), after receiving “detailing” from sales representatives. Id. at 90-94. Relators contend that the off-label promotion of Luvox, Aceon, and AndroGel resulted in prescriptions that were filled by pharmacies and that the pharmacies then submitted false claims to government health care plans, including Medicare, Medicaid, CHAMPUS/TRICARE, CHAMPVA, Federal Employees Health Benefit Plan, and ADAPs. Id. at 107. Relators assert that Solvay’s drugs were added to state Medicare and Medicaid formularies after listings in DRUGDEX Information System supported the off-label uses, even though (1) the FDA speeifically denied approval for some of the off-label uses listed; and (2) many of the sources cited in DRUGDEX in support of the off-label uses (a) failed to support the efficacy of the drugs for the specific uses, (b) were sponsored or authored by defendants or raised another conflict of interest, (c) were from studies that were not subject to peer review, (d) involved too few subjects, (e) lacked controls or had some other research flaw, or (f) were authored by a ghostwriter rather than the listed author. Id. at 108-09. Relators claim that DRUGDEX listed the uses either because it was deliberately mislead by Solvay or colluded with Solvay. Id. at 109. C. Kickbacks In addition to the alleged off-label marketing campaign, Relators claim that Solvay “bribed doctors to use its drugs,” for on- and off-label uses, with unlawful kickbacks such as “bogus speaker and research fees, resort weekends, cash payments, or Harley Davidson goods,” in violation of the AKS. Id. at 122. These violations, in turn, allegedly led to the submission by pharmacies and others of false claims to the government for reimbursement for prescriptions. First, Solvay allegedly had several cash schemes whereby it would offer “incentives” to induce physicians to prescribe high volumes of their drugs. Id. at 123. For example, Solvay allegedly would (1) pay doctors to complete paperwork on patients taking Solvay drugs, claiming it was in the interest of furthering medical knowledge; (2) provide honoraria to speakers, including one instance in which Solvay paid one doctor $10,500 in one month to speak to fewer than 50 people about Aceon and a total of more than $100,000 in 2000 for speaking engagements; (3) hold these speaker engagements at upscale venues or luxury resorts; (4) pay for the speakers’ families to attend these lush events; (5) invite doctors from across the country to fly to a luxury hotel or resort to listen to speakers promote defendants’ drugs, paying for airfare, lodging, and an attendance fee, while claiming the physicians were consultants because they were asked to comment on the effectiveness of sales pitches; (6) provide honoraria to physicians who participated in district and regional advisory boards, which were open venues where off-label indications of defendants’ drugs would be discussed; (7) host dinner meetings that ran afoul of the AKS; (8) host Continuing Medical Education (“CME”) dinners of off-label topics and, in the early years, provide physicians with a $100 gift certificate for attending the events; (9) arrange for roundtable dinner meetings (or golf outings) hosted by a regional physician; (10) engage in preceptorships during which a physician allows a sales representative to shadow him or her for part of a day for fees ranging from $150 to $1,000; and (11) provide honoraria or grants for bogus clinical trials, studies, or focus panels. Id. at 123-37. Solvay also allegedly offered non-cash kickbacks to induce physicians to prescribe its drugs. Examples include the following perks, which allegedly were received by physicians who were willing to listen to a sales pitch or presentation about Solvay’s drugs: Lunch-N-Learn (food from a popular restaurant for the doctor and his or her staff); Dine N’ Dash (free meals for physicians to take home to their families from a popular restaurant); Book-N-Dash (gift certificate to a book store); and Flowers-in-a-Flash (free flowers at a local flower shop). Id. 137-43. Relators claim that Solvay provided these kickbacks so that physicians would prescribe the Drugs at Issue to individuals on government health plans. Relators assert that Solvay specifically targeted its marketing schemes to physicians who had a high percentage of patients on government health plans and that it targeted physicians who were on the Medicaid Pharmaceutical and Therapeutic (“P & T”) committees of various states • by “shower[ing] the member with offers of gifts, dinners, and every kind ■ of bribe in exchange for hearing Solvay’s off-label details,” in an effort to ensure that the Drugs at Issue were listed on the states’ formularies. Id. at 116. Relators provide several examples of prescriptions for S.olvay drugs written by physicians after receiving an alleged kickback. Id. at 144-46 & Exhs. 131-33. D. ICD-9 Code Manipulation Under the Medicaid program, states may only restrict coverage of drugs if (1) “the prescribed use is not for a medically accepted indication”; (2) the drug is in the list contained in subsection 1396r-8(d)(2), which includes, for example, fertility drugs, prescription vitamins, and nonprescription drugs; (3) the drug manufacturer agreed to restrictions in an agreement with Medicaid; or (4) the State excluded the drug from its formulary. 42 U.S.C. § 1396r — 8(d)(1)(B). A State can exclude a covered outpatient drug from its formulary “only if ... the excluded drug does not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness, or clinical outcome of such treatment for such population over other drugs included in the formulary and there is a written explanation ... of the basis for the exclusion.” 42 U.S.C. § 1396r-8(d)(4)(C). However, if a State excludes a drug from its formulary, it must permit coverage of the drug pursuant to a prior authorization program that complies with the Medicaid statute. See id. § 1396r-8(d)(4)(D). Relators claim that Luvox, Aceon, and AndroGel each require prior authorization in some states. Dkt. 114 at 18. In order to obtain prior authorization for drugs that are excluded from state formularies, physicians generally must state why the drug is necessary and provide a written diagnosis. Dkt. 114 at 17. This diagnosis may be written using an ICD-9 code, which is a coding system used by Medicaid to designate diagnoses. Dkt. 114 at 17. Relators allege, upon information and belief, that “certain state Medicaid programs will reimburse for pharmaceutical drugs only if the drug corresponds with a specific diagnosis of the patient, designated by an ICD-9 code recorded by the patient’s physician.” Dkt. 114 at 18. Relators assert that Solvay provided ICD-9 codes to physicians in states that required prior authorization before the Drugs at Issue could be prescribed. Relators claim that the provided ICD-9 codes, which were allegedly codes for conditions for which physicians could obtain prior authorization for the drügs, were part of an effort to conceal the real reasons the drugs were prescribed in order to obtain reimbursement for the drugs from Medicare, Medicaid, and other federal healthcare programs. Id. at 115, 146. Relators provide examples of physicians that used ICD-9 codes that Solvay allegedly provided when submitting prior authorization forms for state Medicaid programs. Id. II. Analysis: SPI’s Motion to Dismiss SPI moves for dismissal of Relators’ claims for violations of the FCA contained in the 4AC,. asserting that the claims are insufficiently pled under Federal' Rules of Civil Procedure 8(a), 9(b), and 12(b)(6), that the retaliation claim should be dismissed as time-barred, that the state qui tarn claims should be dismissed for state-specific pleading deficiencies, and that count 34 should be dismissed because there is no cause of action for a “common fund relief.” Dkt. 122. A. Legal Standards 1. Rule 12(b)(6) Standard “Federal Rule of Civil Procedure 8(a)(2) requires only ‘a short and plain statement of the claim showing that the pleader is entitled to relief,’ in order to ‘give the defendant fair notice of what the ... claim is and the grounds upon which it rests.’ ” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 1964-65, 167 L.Ed.2d 929 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957)). In considering a 12(b)(6) motion to dismiss a complaint, courts generally must accept the factual allegations contained in the complaint as true. Kaiser Aluminum & Chem. Sales, Inc. v. Avondale Shipyards, Inc., 677 F.2d 1045, 1050 (5th Cir.1982). The court does not look beyond the face of the pleadings in determining whether the plaintiff has stated a claim under Rule 12(b)(6). Spivey v. Robertson, 197 F.3d 772, 774 (5th Cir.1999). “[A] complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, [but] a plaintiffs obligation to provide the ‘grounds’ of his ‘entitle[ment] to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Twombly, 127 S.Ct. at 1964-65 (citing Sanjuan v. Am. Bd. of Psychiatry and Neurology, Inc., 40 F.3d 247, 251 (7th Cir.1994)) (internal citations omitted). And, “[fjactual allegations must be enough to raise a right to relief above the speculative level.” Twombly, 127 S.Ct. at 1965. The supporting facts must be plausible— enough to raise a reasonable expectation that discovery will reveal further supporting evidence. Id. at 1959. 2. Rule 9(b) Standard In addition to meeting the plausibility standard, under Federal Rule of Civil Procedure 9(b), if a party is alleging fraud or mistake, the pleading must “state with particularity the circumstances constituting fraud or mistake.” Fed.R.Civ.P. 9(b); United States ex rel. Grubbs v. Kanneganti, 565 F.3d 180, 185 (5th Cir.2009) (noting that Rule 9(b) does not “supplant” Rule 8(a)). However, this particularity requirement “does not ‘reflect a subscription to fact pleading.’ ” Id. (quoting Williams v. WMX Techs., Inc., 112 F.3d 175, 178 (5th Cir.1997)). Instead, pleadings alleging fraud must contain “simple, concise, and direct allegations of the circumstances constituting the fraud, which ... must make relief plausible, not merely conceivable, when taken as true.” Id. (internal quotations omitted) (referring to the standard enunciated in Twombly). The Fifth Circuit interprets Rule 9(b) strictly, “requiring a plaintiff pleading fraud to specify the statements contended to be fraudulent, identify the speaker, state when and where the statements were made, and explain why the statements were fraudulent.” Id. (quoting Herrmann Holdings Ltd. v. Lucent Techs. Inc., 302 F.3d 552, 564-65 (5th Cir.2002)). Thus, Rule 9(b) generally requires the complaint to “set forth ‘the who, what, when, where, and hov/ of the events at issue.” Id. (quoting ABC Arbitrage Plaintiffs Grp. v. Tchuruk, 291 F.3d 336, 350 (5th Cir.2002)). However, “Rule 9(b)’s ultimate meaning is context-specific.” Grubbs, 565 F.3d at 185. Thus, “[depending on the claim, a plaintiff may sufficiently ‘state with particularity the circumstances constituting fraud or mistake’ without including all the details of any single court-articulated standard — it depends on the elements of the claim at hand.” Id. B. Counts I and II: Federal FCA Presentment and False Record Claims SPI claims that Relators failed to plead their claims of violations of the FCA with the specificity required under Federal Rule of Civil Procedure 9(b), as the off-label promotion claims provide no basis for finding a nationwide epidemic of claims for prescriptions for off-label use written in response to off-label promotion, the unlawful kickback claims do not allege who was paid a kickback or how that kickback led to the submission of a false claim, and the ICD-9 Code manipulation claims do not connect any false claims to the alleged manipulated codes. Dkt. 122 at 11. SPI additionally claims that, under Federal Rule of Civil Procedure 12(b)(6), Relators’ allegations of FCA violations relating to unlawful kickbacks fail because Relators do not plead a viable false certification theory, and the violations with regard to off-label promotion and ICD-9 manipulation fail because Relators do not allege facts showing a material falsity that rendered pharmacy prescription claims non-reimbursable. Id. at 12. Relators argue that the allegations in the 4AC lead to a strong inference that at least one false claim was submitted to the Government, and that Rule 9(b) does not require that the complaint allege the time, place, and contents of the actual claim submissions. Dkt. 131. As for SPI’s 12(b)(6) arguments, Relators contend that kickback-tainted claims are inherently false, so pleading false certification in not necessary. Id. They claim, however, that, regardless, they have plausibly pled that physicians, pharmacists, and third-party payers made false certifications representing to the Government that they had complied with all federal and state laws and regulations relating to fraud, including the AKS. Dkt. 131 at 26. Relators additionally argue that they have plausibly alleged that off-label and ICD-9 code claims were not reimbursable. 1. The FCA The FCA provides for civil suits brought by either the Attorney General or private persons, known as “relators,” “who serve as a ‘posse of ad hoc deputies to uncover and prosecute frauds against the government.’ ” Grubbs, 565 F.3d at 184 (quoting United States ex rel. Milam v. Univ. of Tex. M.D. Anderson Cancer Ctr., 961 F.2d 46, 49 (4th Cir.1992)). If a private person- desires to bring a suit under the FCA as a relator, the suit is known as a qui tam suit. See id. The relator must file the qui tam action in the name of the Government, under seal, and serve the complaint and the material evidence on the Government. 31 U.S.C. § 3730(b) (2006).. The complaint must remain under seal for 60 days, during which the Government may either elect to intervene and proceed-with the action - or notify the court that it declines to intervene. Id. If the Government elects not to intervene, the relator has the- right to proceed with the action. Id. § 3730(c)(3). Under the current version of seqtion 3729(a)(1) of the FCA, [A]ny person who— (A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; [or] (B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim; is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, ... plus 3 times the amount of damages which the Government sustains because of the act of that person. 31 U.S.C.A. § 3729(a) (Supp.2011). Under the previous version of the relevant subsections of section 3729(a), [A]ny person who— (1) knowingly presents, or causes to be presented, to an officer or employee of the United States Government ... a false or fraudulent claim for payment or approval; [or] (2) knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Government; is liable to the United States Government. ... 31 U.S.C. § 3729(a) (2006). The amendments, which were enacted in 2009, generally apply to conduct on or after May 20, 2009. However, the amendment to the previous subsection 3729(a)(2), which renumbered the subsection as 3729(a)(1)(B) and changed the text, “applies retroactively to all claims pending on or after June 7, 2008.” United States ex rel. Steury v. Cardinal Health, Inc., 625 F.3d 262, 267 & n. 1 (5th Cir.2010). The Fifth Circuit interprets “claims” to mean cases or causes of action rather than claims for reimbursement. See id. Since this case was pending on June 7, 2008, the new subsection 3729(a)(1)(B) applies. See id. (applying the new subsection because the case was pending on June 7, 2008); see also United States ex rel. Patton v. Shaw Servs., L.L.C., 418 Fed.Appx. 366 (5th Cir.2011) (noting that the relator’s complaint was “pending” after the effective date of the new subsection, indicating that the new subsection should apply, but determining that the difference between the old and new subsections was irrelevant under the facts of that case). But see United States ex rel. Bennett v. Medtronic, Inc., 747 F.Supp.2d 745, 763 (S.D.Tex.2010) (collecting district court cases) (finding that the revised version of the subsection did not apply to a case that was pending on June 7, 2008, because Congress made the revision retroactive to claims pending on June 7, 2008, and “claims” under the FCA means claims for reimbursement, not cases or causes of action). However, the older version of 3729(a)(1) (now 3729(a)(1)(A)) applies. The Fifth Circuit has summarized the requirements of a claim under the FCA: “(1) a false statement or fraudulent course of conduct; (2) made or carried out with the requisite scienter; (3) that was material; and (4) that is presented to the Government.” Steury, 625 F.3d at 267. As for scienter, the relevant provisions require “knowing” conduct, and the FCA defines “knowing” and “knowingly” as having “actual knowledge of the information,” acting “in deliberate ignorance of the truth or falsity of the information,” or acting “in reckless disregard of the truth or falsity of the information.” 31 U.S.C. § 8729(b)(1)(A); see also Steury, 625 F.3d at 267 (applying this definition). “Material” means “having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.” 31 U.S.C. § 3729(b)(4)(2009) (defining “material” for conduct after May 20, 2009); United States ex rel. Longhi v. United States, 575 F.3d 458, 470 (5th Cir.2009) (requiring materiality under both subsection 3729(a)(2) (2006) and 3729(a)(1)(B) (2009) and defining “materiality” as having a “natural tendency to influence, or ... capable of influencing, the decision of the decisionmaking body to which it was addressed” (citations and quotations omitted)). The “natural tendency” test requires “that the false or fraudulent statements either (1) make the government prone to a particular impression, thereby producing some sort of effect, or (2) have the ability to effect the government’s actions, even if this is the result of indirect or intangible actions on the part of the Defendants.” Longhi, 575 F.3d at 470. Thus, the statements must “have the potential to influence the government’s decisions.” Id. 2. Rule 9(b) SPI argues that Relators’ FCA claims stemming from alleged off-label promotion, kickbacks, and ICD-9 code manipulation should be dismissed under Rule 9(b) because Relators fail to set forth the “ ‘who, what, when, where, and how of the alleged fraud.’ ” Dkt. 122 at 12 (quoting Steury, 625 F.3d at 266). SPI contends that Relators must plead the specifics of a scheme to cause claims to be submitted for non-reimbursable uses and details of the claims. Id. at 15. Relators argue that, under Rule 9(b), the complaint must set forth the time, place, contents, and identity surrounding the fraud, but they contend that there is no requirement to plead the time, place, contents, and identity of the actual submissions to the Government. Dkt. 131 at 6. The Fifth Circuit squarely addressed how much specificity is required under subsections 3729(a)(1) and (2) (2006) of the FCA in Grubbs. In Grubbs, James Grubbs, a psychiatrist who had worked for Memorial Hermann Baptist Beaumont Hospital (the “Hospital”), brought a qui tarn complaint against the Hospital and seven physicians who worked at the hospital. Grubbs, 565 F.3d at 183. Grubbs alleged that the physicians at the Hospital saw patients only on an “as needed” basis, when the nursing staff felt it was appropriate, but the bill reflected a regular “face-to-face” hospital visit. Id. at 184. The Grubbs defendants filed a motion to dismiss for failure to comply with the pleading requirements of Federal Rule of Civil Procedure 9(b), and the magistrate judge recommended dismissal. Id. at 185. The district court adopted the magistrate judge’s recommendation, and Grubbs appealed. Id. The Fifth Circuit first noted that a complaint filed under the FCA must meet the heightened pleading requirement of Rule 9(b). Id. Under Rule 9(b), a party alleging fraud or mistake “must state with particularity the circumstances constituting fraud or mistake.” Fed.R.Civ.P. 9(b). Rule 9(b) “has long played [a] screening function, standing as a gate-keeper to discovery, a tool to weed out meritless fraud claims sooner than later.” Grubbs, 565 F.3d at 185. “Rule 9(b) does not ‘reflect a subscription of fact pleading’ and requires only ‘simple, concise, and direct’ allegations of the ‘circumstances constituting fraud,’ which after Twombly must make relief plausible, not merely conceivable, when taken as true.” Id. at 186 (quoting Williams, 112 F.3d at 178). The Fifth Circuit, which “traditionally required that a fraud complaint include ‘the time, place and contents of the false representation[ ], as well as the identity of the person making the misrepresentation and what that person obtained thereby,’ ” instructed that the Rule’s requirements are context-specific and “thus there is no single construction of Rule 9(b) that applies in all contexts.” Id. at 188 (quoting United States ex rel. Russell v. Epic Healthcare Mgmt. Grp., 193 F.3d 304, 308 (5th Cir.1999)). The Grubbs court determined that, in the context of a claim under subsection 3729(a)(1) (2006) of the FCA, the Act does not require the litigant to prove reliance or damages, it “is adequate to allege that a false claim was knowingly presented regardless of its exact amount; the contents of the bill are less significant - because a complaint need not allege that the Government relied on or was damaged by the false claim.” Id. at 189. A “plaintiff does not necessarily need the exact dollar amounts, billing numbers, or dates to prove to a preponderance that fraudulent bills were actually submitted.” Id. at 190. The Fifth Circuit held that “to plead with particularity the circumstances constituting fraud for a False Claims Act § 3729(a)(1) claim, a relator’s complaint, if it cannot allege the details of an actually submitted false claim, may nevertheless survive by alleging particular details of a scheme to submit false claims paired with reliable indicia that lead to a strong inference that claims were actually submitted.” Id. The Fifth Circuit determined that the Grubbs complaint against the individual doctors pursuant to section 3729(a)(1) (2006) was sufficient to satisfy the requirements of Rule 9(b) because Grubbs set forth the details of the scheme as well as the specific dates that each doctor falsely claimed to have provided services to patients as well as, in some instances, the type of medical services or the procedural terminology code that would have been used to bill. Grubbs, 565 F.3d at 191-92. The Fifth Circuit noted that the list of dates that spécifíed, unprovided services were recorded “amounts to more than probable, nigh likely, circumstantial evidence that the doctors’ fraudulent records caused the hospital’s billing system in due course to present fraudulent claims to the Government.” Id. at 192. “That the fraudulent bills were presented to the Government is the logical conclusion of the particular allegations in Grubbs’ complaint even though it does not include exact billing numbers or amounts.” Id. With regard to the claims under subsection 3729(a)(2) (2006), the Fifth Circuit noted that, to satisfy subsection 3729(a)(2) (2006), the defendant must make “a false record or statement for the purpose of getting a false or fraudulent claim paid by the Government.” Grubbs, 565 F.3d at 193. Thus, “the recording of a false record, when it is made with the requisite intent, is enough to satisfy the statute.” Id. There is no need to infer that the record caused a claim to be presented. Id. Therefore, Grubbs’ allegations that two of the physicians explained how the nursing staff wrote notes relating to face-to-face visits with patients that were actually only seen on an as-needed basis, that the nursing staff attempted to assist him in recording such notes, and that certain doctors recorded false notes on specific dates, were sufficient to state a claim for fraud under subsection 3729(a)(2) (2006) and should not have been dismissed at the pleading stage. Id. Under the subsection 3729(a)(1)(B) (2009), the phrase “to get a false or fraudulent claim paid or approved by the Government,” which was used in the previous version, has been replaced with “material to a false or fraudulent claim.” Compare 31 U.S.C. § 3729(a)(1)(B) (2009), with 31 U.S.C. § 3729(a)(2) (2006). The first part of the subsection, “knowingly makes, uses, or causes to be made or used, a false record or statement,” remains unchanged. While the Grubbs court did not require presentment of the claim or subsection 3729(a)(1) (2006) claims, it is unclear whether the new version requires presentment. Thus, in this case, in order for the subsection 3729(a)(1) (2006) claims to survive Solvay’s Rule 9(b) challenge, the 4AC must allege “particular details of a scheme to submit false claims paired with reliable indicia that lead to a strong inference that claims were actually submitted.” The “logical conclusion” of the allegations must be that fraudulent claims were submitted to the government. And, the subsection 3729(a)(1)(B) (2009) claims can survive only if the 4AC alleges that Solvay made a false record or statement that was material to a false or fraudulent claim, i.e. that had the potential to influence the government’s decision. The court turns first to the subsection 3729(a)(1) (2006) claims. a. Subsection 3729(a)(1) (2006) Off-Label Promotion Claim SPI argues that, under Grubbs, Relators must pair their allegations of a scheme with “details ‘such as dates and descriptions of recorded, but unprovided, services and a description of the billing system that the records were likely entered into.’ ” Dkt. 122 at 15 (quoting Grubbs, 565 F.3d at 190-91). SPI states that Relators have not identified any instance in which a physician actually wrote a prescription for a federal program patient because of an alleged off-label promotion scheme and a pharmacy submitted a claim for that off-label prescription. Id. Relators, on the other hand, claim that the 4AC provides reliable indicia that claims were actually submitted and that they are not required to “plead the who, what, when, where, and how of a claim. ” Dkt. 131 at 7. Relators claim that they have pled the who, what, when, where, and how of the alleged fraudulent scheme in detail, including alleging the identities of brand managers and other executives involved in the alleged scheme, discussion of the official brand strategy, alleged illegal tactics endorsed for achieving off-label sales, and informal and formal selling practices. Dkt. 131 at 8. Relators contend that this information is sufficient, alone, to state a claim under Grubbs; however, they claim they have pled “more than was required,” as they have pled “ample ‘representative samples’ of off-label claims submitted to Medicaid for each of the three drugs” at issue. Id. at 12 (citations omitted). 1. Reliable indicia of that the off-label marketing scheme caused physicians to write off-label prescriptions The 4AC includes substantial allegations that Texas physicians wrote off-label prescriptions for Luvox, AndroGel, and Aceon for federal program patients. E.g., Dkt. 114 at 50, 63, 90. SPI claims, however, that the 4AC fails to assert that the alleged off-label promotion caused a specific physician or physicians to write these prescriptions. Dkt. 122 at 17-18. SPI contends that this court, in Bennett v. Medtronic, “rejected similarly lacking allegations just months ago.” Dkt. 122 at 18 (citing Bennett, 747 F.Supp.2d 745). In Bennett, the court considered whether to dismiss a qui tam FCA claim alleging that off-label promotion of a medical device caused physicians and hospitals to submit false Medicare and Medicaid claims. 747 F.Supp.2d at 748. The court determined that the relators “failed to plead with sufficient particularity the alleged false claims, [as the] relators [did] not identiffy] any [of the defendant’s] employees who engaged in off-label promotion nor specific physicians or hospitals who received the promotions.” Bennett, 747 F.Supp.2d at 779. Additionally, the Bennett relators did not identify any physicians to whom the defendant promoted its medical device for off-label use who actually submitted false claims to the Government for off-label use. Id. The Bennett court distinguished Grubbs, finding that, unlike the plaintiffs in Grubbs, the Bennett relators’ complaint did “not sufficiently allege[ ] that by promoting off-label use, [the defendant] caused the submission of false claims and is liable under the FCA.” Id. at 780-81 (emphasis added). Here, Relators’ contentions relating to the off-label promotion scheme paired with the promotion and prescription details outlined relating to individual Texas physicians in the 4AC are reliable indicia that permit a strong inference that the off-label promotion scheme caused at least some physicians to write off-label prescriptions for Luvox, Aceon, and AndroGel. Unlike the complaint in Bennett, which did not identify any physicians who received the alleged off-label promotions (see 747 F.Supp.2d at 779), the instant complaint identifies specific physicians in Téxas who prescribed Luvox, Aceon, and AndroGel to Medicaid patients for off-label use after sales representatives “pitched” these uses during sales calls or who attended presentations that specifically discussed the off-label uses. Dkt. 114 at 50. For example, on December 31, 1999, a sales representative documented a “pitch” to a doctor in which the representative discussed geriatric safety of Luvox based on pediatric safety. This physician prescribed Luvox to a 74-year-old patient for anxiety on March 11, 2000, and to a 78-year-old patient for paranoia on September 7, 2000; these are both uses that are not indicated on Luvox’s label. Dkt. 114 & Exh. 18. With regard to AndroGel, the 4AC identifies, for ‘ example, two physicians who wrote Medicaid prescriptions for AndroGel for off-label conditions associated with “andropause” after receiving and being encouraged to use the ADAM questionnaire from Solvay, which is aimed at detecting “andropause.” Dkt. 114 at 92-93 & Exhs. 72, 74. The 4AC additionally provides examples of physicians who received extensive detailing, from Solvay about AndroGel and subsequently prescribed AndroGel for off-label uses. Dkt. 114 at 90-94. Relators do not provide any details about what the sales representatives said during the sales calls, so the court does not rely on these examples alone to determinate that Relators have provided reliable indicia that off-label promotion led to off-label claims, but these examples buttress the examples provided that are linked to specific promotional messages, and, when paired with these specific examples and all of the details provided about the off-label campaigns, constitute reliable indicia permitting the necessary inference. Thus, there is specific support for Relators’ contention that physicians indeed wrote prescriptions for off-label uses of AndroGel after receiving off-label promotion. There is less evidence of causation in the 4AC with regard to Aceon, but the court finds that the examples provided reliably indicate that Solvay’s off-label marketing of Aceon led to off-label prescriptions. For instance, the 4AC identifies several physicians who began prescribing Aceon extensively to Texas Medicaid patients after attending talks in which arterial wall compliance and the diabetic kidney were discussed, yet had never prescribed Aceon before attending the talks. Dkt. 114 at 63 & Exh. 35, 36. SPI argues that this example is not reliable because the prescriptions were “for an unidentified indication.” Dkt. 122 at 16. Relators’ attached charts, however, provide diagnosis information. See Dkt. 114, Exh. 36. Moreover, the chart at Exhibit 36a provides a list of prescriptions of Aceon written for diabetic patients by these doctors, and the chart at Exhibit 36b provides a list of prescriptions for Aceon written for stroke patients by these doctors. Dkt. 114 at 63 & Exh. 36a-b & Exh. Index. Relators’ two most extensively alleged off-label promotion claims for Aceon (24-hour control/diabetic kidney and PROGRESS/stroke prevention) were allegedly specifically targeted at physicians with diabetic and stroke patients. Dkt. 114 at 53-60. The court finds that the examples when considered in light of the other information in the 4AC provide reliable indicia that Solvay’s off-label promotion of Aceon caused physicians to prescribe Aeon for off-label uses. SPI also argues that Relators must provide details of instances in which SPI allegedly promoted each Drug at Issue to a physician for each alleged off-label use and caused a physician to write a prescription for that off-label use that was ultimately filled. Dkt. 122 at 15-17. Relators have provided representative examples for multiple alleged off-label uses for these drugs, but they have not provided examples of every alleged off-label use. Relators have alleged a nationwide off-label promotion scheme involving multiple drugs with multiple off-label uses, and with such an extensive scheme, it is not practical to provide specific details about prescriptions for every alleged off-label use at the pleading stage. Grubbs simply requires reliable indicia that lead to a strong inference that claims were actually submitted. Here, the court finds that the allegations relating to the off-label promotion scheme for each off-label use paired with the examples that show that some of the off-label promotion led to prescriptions for some of the off-label uses meets that standard. Moreover, the heightened 9(b) pleading standard “stems from the obvious concerns that general, unsubstantiated charges of fraud can do damage to a defendant’s reputation.” Guidry v. Bank of LaPlace, 954 F.2d 278, 288 (5th Cir.1992). In the court’s view, the lack of examples for some of the off-label promotion claims does not threaten SPI’s reputation with unsubstantiated charges given the number of examples of promotion for off-label uses that are substantiated. 2. Reliable Indicia Off-Label Claims Submitted to Government SPI claims that “[gjeneral off-label promotion allegations that are not linked to particularized details reliably demonstrating that false claims resulted do not state a FCA claim.” Dkt. 122 at 17. SPI contends that Relators must allege the submission of a claim for payment to the government for a non-reimbursable, off-label use as a result of improper off-label promotion. Id. SPI argues that Relators’ failure to provide “details like dates and descriptions of pharmacies submitting claims” is fatal to their claim. Id. at 16. Relators claim, on the other hand, that the 4AC contains sufficient reliable indicia to raise a strong inference that claims arising from Solvay’s alleged schemes were actually submitted to the government. Dkt. 131 at 8. First, Relators indicate that they have intimate knowledge of Solvay’s off-label schemes due to their positions as district managers in the company. Id. at 9. Relators claim that their “supervisors trained them in various off-label tactics and directed them to teach them in turn to their representatives.” Id. at 9. Second, Relators claim that Solvay specifically targeted physicians who prescribed to patients on government health programs as well as physicians who were on state P & T committees, which made decisions about which drugs to include on state formularies, so that physicians would prescribe the Drugs at Issue to patients on government health programs and the government would provide reimbursement for the prescriptions. Id. SPI cites United States ex rel. Rafizadeh v. Continental Common, Inc., 553 F.3d 869 (5th Cir.2008), in support of its contention that the allegations in the 4AC are insufficient under Rule 9(b) because they are not particularized enough to demonstrate that false claims were actually submitted to the government. In Rafizadeh, the Fifth Circuit considered whether a district court erred in dismissing, with prejudice, a qui tarn suit alleging that landlords overcharged government entities on lease agreements. 553 F.3d at 872. The pleading in Rafizadeh indicated that the defendants knowingly submitted false claims for rental invoices to the state departments in charge of the program, which caused them to submit false claims to the federal government, which was obligated to fund the state departments’ budgets. The Fifth Circuit noted that “the linchpin of an FCA claim is a false claim” and determined that the allegation that claims were submitted was insufficient under Rule 9(b) because it did “not describe what statements were contained in the budget, who prepared it, or what role it played in securing funding from the federal government.” Id. at 873. Thus, the details of the “claims” were not sufficiently particularized. Id. Here, like in Rafizadeh, the details provided of the actual claims submitted to government payers are not substantial. However, there are enough other facts alleged that reliably indicate that false claims were submitted to government agencies. The 4AC provides many details that strongly suggest that Solvay’s alleged off-label marketing scheme resulted in claims being submitted to the government for payment. First, it is clear that there were claims submitted to government payers for off-label uses of the Drugs at Issue, as Relators provide claims data indicating that Texas physicians wrote prescriptions for off-label uses of the Drugs at Issue to patients on Texas Medicaid and that these prescriptions were filled. See Dkt. 114 at 50, 64-65, 93-94. Second, the 4AC indicates that off-label prescriptions were likely submitted to government payers because Solvay allegedly specifically targeted its marketing to physicians that prescribe drugs to patients who are on government health programs. See id. at 107, 111-22. For example, Relators allege that Solvay put stickers on samples reminding physicians that the drugs were covered by Medicaid and that Solvay district managers used prescribing information data to shape their marketing pitches to individual physicians who wrote prescriptions to individuals on Medicaid. Id. 113-14. Solvay also allegedly targeted physicians who were members of state P & T committees, in an attempt to obtain favorable treatment on state formularies. Id. at 116-19. Taken together, these allegations raise a strong inference that claims were actually submitted to the government for reimbursement. In sum, the 4AC plausibly alleges a nationwide off-label promotion scheme to submit false claims for each of the Drugs at Issue and reliable indicia leading to a strong inference that claims were actually submitted, and thus survives SPI’s Rule 9(b) challenges. SPI’s motion to dismiss based on failure to allege the off-label promotion claims with particularity is DENIED. SPI’s other requests for dismissal relating to off-label promotion are made pursuant to Rule 12(b)(6) rather than 9(b) and will accordingly be analyzed after the court addresses SPI’s Rule 9(b) challenges relating to kickbacks and ICD-9 codes, b. Alleged Kickbacks In the 4AC, Relators contend that Solvay’s alleged unlawful attempts to induce physicians to prescribe its drugs include a scheme to provide kickbacks to physicians for prescribing the Drugs at Issue. Relators claim that “Solvay’s off-label marketing and kickbacks schemes went hand-in-hand to induce high-Medicaid prescribing — physicians to prescribe and continue prescribing Solvay drugs.” Dkt. 131 at 19. Relators assert that “Solvay bribed doctors to use its drugs” with “bogus speaker and research fees, resort weekends, cash payments, or Harley Davidson goods.” Dkt. 114 at 122. Relators contend that Solvay’s provision of these kickbacks was a violation of the Medicare-Medicaid Anti-Fraud and Abuse Amendments (“Anti-Kickback Statute” or “AKS”) and that any claims resulting from the unlawful kickbacks were in violation of the FCA. SPI moves for dismissal of Relators’ kickback claims under Rule 9(b), claiming that the 4AC fails to provide “any details about any false claim resulting from the variety of kickback ‘schemes’ ” that Relators allege and that the 4AC provides no details upon which to base a strong inference that false claims were submitted. Dkt. 122-2 at 19 (citing Grubbs, 565 F.3d at 190-91). SPI argues that in order to meet the Grubbs reliable indicia standard, Relators must allege “when SPI paid a physician an unlawful kickback with the requisite intent to cause a prescription to be written for one of those drugs for a government program patient, what prescriptions were caused by that kickback, and how the government was billed for those prescriptions.” Dkt. 139 at 3-4. SPI claims that no allegations in the 4AC connect the alleged kickbacks to a resulting prescription from a doctor or a pharmacy’s claim for payment. Dkt. 122 at 19-20. As for the specific examples that are contained within the 4AC, SPI notes that they only relate to “a handful of physicians” who allegedly prescribed a Solvay drug within four years of receiving a speaker fee for participating in Solvay speaker programs. Id. at 20. Solvay asserts that these physicians are all from Texas and therefore offer no support for .allegations outside of Texas and that many of the allegations involve, prescriptions that were written years after the alleged kickback and therefore provide no reliable link. Id. at 20-21. Additionally, SPI asserts, that the -4AC makes no mention of any claims allegedly resulting from several of the specific types of kickbacks, so the claims relating to these types of kickbacks are not particularized in accordance with Rule 9(b). ■ Dkt. 122 at 19. Despite the fact that the claims data that the 4AC uses to link specific physicians who allegedly received kickbacks to Medicaid prescriptions for the Drugs at Issue are all from Texas, Relators have alleged enough details of a geographically diverse kickback scheme to reliably indicate that there was a nationwidé kickback scheme. They have alleged their own personal knowledge of the kickback scheme as Solvay sales managers, and they have provided details of specific types of kickbacks provided in different parts of the country, including an internal Solvay audit report that indicates various types of gifts were given to physicians in Louisiana and Texas, information about physicians in West Virginia to whom King, in his capacity as a sales representative, provided kickbacks (in the form of speaker’s fees), and information about roundtables at upscale resorts in different areas of the country where Solvay allegedly paid for physicians’ and their families’ rooms, meals and activities, golf, and a show in the evening, as well as specific allegations relating to physicians receiving kickbacks in Virginia, Georgia, North Carolina, and Alabama. Dkt. 114 at 10, 102-03, 124-25, 140-44 & Exh. 1; See Dkt. 131 at 17. The 4AC alleges that some events, such as resort weekend in Arizona involving only “six hours of meetings and plenty of time for golf’ were organized “out of headquarters.” Dkt. 114 at 124-25. The 4AC reliably indicates that the alleged kickbacks resulted in prescriptions to patients on government health plans and leads to a strong inference that claims were actually submitted. First, the 4AC indicates that the physicians Solvay targeted to receive off-label promotion were also targeted for kickbacks-physieians who prescribed to patients on Medicaid and other government health plans and physicians who were on state P & T committees. Dkt. 114 at 116. For instance, Solvay managers allegedly considered doctors’ Medicaid prescription volume when determining’ which doctors to target for kickbacks. Dkt. 114 at 113-15. Solvay also specifically targeted members of states’ Medicaid P & T committees in an effort to obtain placement of their drugs on the state formularies, allegedly showering the committee members with offers of gifts, dinners, and bribes. Dkt. 113 at 116. Relators provide a specific example of a Solvay Regional Business Director who “encouraged his sales team members to ‘wine and dine’ these doctors, even doctors who never prescribed Solvay drugs or were retired,” in an obvious attempt to influence P & T committees. Id. at 117. Moreover, the specific examples that Relators provide of physicians who prescribed the Drugs at Issue after receiving alleged kickbacks demonstrate that physicians who received alleged kickbacks in fact did write prescriptions for patients on Medicaid. Solvay argues that the provided examples are not sufficient because (1) the examples are all from Texas and thus do not support Relators’ nationwide contentions; (2) there are not examples for each of the alleged kickback schemes contained within the 4AC; and (3) the prescriptions in the examples are not temporally linked to the alleged kickbacks. Dkt. 122 at 20-21; 139 at 9. First, the examples of Texas physicians who prescribed Solvay drugs after receiving kickbacks lead to a strong inference that this also happened in other parts of the country. Solvay claims that the district court for the Eastern District of Arkansas, in United States ex rel. Thomas v. Bailey, No. 4:06CV00465 JLH, 2008 WL 4853630, at *6 (E.D.Ark. Nov. 6, 2008), held that a relator who identified only a “handful of physicians” who allegedly received kickbacks did not support the allegation of a nationwide policy. Dkt. 122 at 19. However, in Thomas the relator specified false claims with respect to only two physicians. 2008 WL 4853630, at *6. The alleged false claims specified in this case are significantly more extensive. See Dkt. 114 at 144 — 46 & Exhs. 131-33. Moreover, the 4AC alleges that some of the kickback schemes were organized by company headquarters and implemented nationwide. See, e.g., Dkt. 114 at 124-25. Second, while Relators have not provided representative examples of false claims submitted for every alleged type of kickback scheme in the 4AC, the different schemes are alleged in detail, and there are representative examples that some of these alleged schemes resulted in claims to government health care programs. See Dkt. 114 at 122-46. Thus, there are reliable indicia that false claims resulting from kickbacks were submitted to government health care programs. Specific examples linking prescriptions to every type of kickback alleged is unnecessary, as Solvay has sufficient notice of the types of kickbacks alleged and can prepare its case accordingly- Third, the specific Medicaid prescriptions for Aceon described in the 4AC are sufficiently linked to kickbacks as the physicians who wrote the prescriptions allegedly received kickbacks. The 4AC provides examples of physicians who prescribed Aceon within one to two months of attending programs offering cash kickbacks for prescribing Aceon. See id. at 136, 145 & Exh. 132. Solvay claims that the 4AC contains no link between a kickback and prescriptions that the physicians wrote years later, and it cites United States ex rel. Foster v. Bristol-Myers Squibb Co., 587 F.Supp.2d 805, 824 (E.D.Tex.2008) in support of its position. In Foster, the federal district court in the Eastern District of Texas dismissed a kickback claim because it was “without information to suggest that kickbacks induced any recommendation connected to ... federal healthcare patients.” 587 F.Supp.2d at 824. The Foster relator provided information about alleged kickbacks but did not provide one factual detail or example of a claim resulting from the kickbacks. Id. Here, Relators provide details and examples. Dr. Fifteen, for example, had never written a prescription for Aceon before February 2000, when he attended his first Solvay City event; Solvay City is a program whereby physicians were allegedly paid cash for providing feedback about Solvay sales pitches. Dkt. 114 at 63-64, 137. After this initial event, Solvay allegedly paid Dr. Fifteen to fly to Milan for the unveiling of the PROGRESS results and, thereafter, Solvay paid Dr. Fifteen to give presentations about PROGRESS. Dkt. 114 at 64 & Exhs. 37, 38. Dr. Fifteen wrote 365 Medicaid prescriptions for Aceon between February 2000 and June 2005. Dkt. 114 at 64 & Exh. 75. The examples of kickbacks to physicians who prescribed AndroGel to Medicaid patients are not as extensive as the examples for Aceon. The examples are mainly of-kickbacks for speaker programs for Aceon. For instance, Dr. Fifteen received kickbacks for speaking about Aceon, but