202445P.pdf   07/26/2022  United States  v.  Midwest Neurosurgeons, LLC, et al
   U.S. Court of Appeals Case No:  20-2445
   U.S. District Court for the Eastern District of Missouri - Cape Girardeau   
   [PUBLISHED] [Stras, Author, with Loken and Arnold, Circuit Judges] 
   Civil case - False Claims Act. To show a claim is false or fraudulent, 
   plaintiff may show the claim "includes items or services resulting from a 
   violation" of the anti-kickback statute - 42 U.S.C. Sec. 1320a-7b(g); the 
   phrase "resulting from" creates a but-for causal requirement between an 
   anti-kickback violation and the items or services included in the claim; 
   here, the district court did not properly instruct the jury on the but-for 
   causal relationship, and the matter must be reversed and remanded for a 
   new trial; the False Claims Act expressly provides a 
   preponderance-of-the-evidence standard for all essential elements and the 
   government may establish an illegal kickback by a preponderance of the 
   evidence as part of a larger False Claims Act case; as a result,the 
   district court did not err in refusing to give a beyond-a-reasonable doubt 
   instruction regarding the illegal kickback.