Norfolk County Retirement System v. Health Management Associates, Inc. , 608 F. App'x 855 ( 2015 )


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  •               Case: 14-12838     Date Filed: 05/11/2015    Page: 1 of 31
    [DO NOT PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 14-12838
    ________________________
    D.C. Docket No. 2:12-cv-00046-JES-DNF
    MIKLEN SAPSSOV,
    Individually and on behalf of all others
    similarly situated, et al.,
    Plaintiffs,
    NORFOLK COUNTY RETIREMENT SYSTEM,
    individually and on behalf of all others similarly situated,
    Plaintiff - Appellant,
    NEW ENGLAND TEAMSTERS & TRUCKING INDUSTRY PENSION FUND,
    OPERATING ENGINEERS TRUST FUNDS,
    Movants – Appellants,
    versus
    HEALTH MANAGEMENT ASSOCIATES, INC.,
    GARY D. NEWSOME,
    KELLY E. CURRY,
    ROBERT E. FARNHAM,
    Defendants - Appellees.
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    ________________________
    Appeal from the United States District Court
    for the Middle District of Florida
    ________________________
    (May 11, 2015)
    Before MARTIN and FAY, Circuit Judges, and GOLDBERG,* Judge.
    PER CURIAM:
    Plaintiffs-appellants, Norfolk County Retirement System, New England
    Teamsters & Trucking Industry Pension Fund, Operating Engineers Trust Funds
    (collectively, “plaintiffs-appellants”), appeal dismissal of their second-amended
    complaint in this securities-fraud class action, alleging a scheme to defraud
    Medicare by defendants-appellees, Health Management Associates, Inc. (“HMA”)
    and its executives, Gary D. Newsome, Kelly E. Curry, and Robert E. Farnham.
    We affirm.
    I. FACTUAL AND PROCEDURAL BACKGROUND
    HMA, a for-profit corporation incorporated in Delaware and headquartered in
    Naples, Florida, operates acute-care hospitals and other healthcare facilities in non-
    urban areas throughout the United States. The individual defendants-appellees are
    ___________________
    *Honorable Richard W. Goldberg, United States Court of International Trade Judge, sitting by
    designation.
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    current or former directors or officers of HMA. 1 Medicare reimburses healthcare
    providers for medical services provided to individuals covered by the program.
    Most hospitals, including those owned by HMA, derive a substantial portion
    of their revenue from Medicare, which necessitates compliance with its
    requirements to receive reimbursement. When a patient seeks treatment at a
    hospital, physicians have three choices regarding that patient’s disposition: (1)
    admit as an inpatient, (2) admit for observation, or (3) discharge after immediate
    treatment. Both inpatient status and observation status place patients in a hospital
    bed, which may involve one or more overnight stays.
    Inpatient care generally is reserved for patients requiring high-intensity
    services, while observational care involves less-intensive services and consists of a
    hospital stay of eight to forty-eight hours. Medicare reimbursement for inpatient
    care is substantially greater than for observational care. Medicare will reimburse
    hospitals for services and treatment that are “reasonable and necessary.” 42 U.S.C.
    § 1395y(a)(1)(A).
    1
    Gary Newsome has served as HMA President and Chief Executive Officer since September 15,
    2008, and also is a member of the HMA Board of Directors. Kelly Curry has served as HMA
    Vice President and Chief Financial Officer since January 10, 2010. Robert Farnham was HMA
    Senior Vice President and Chief Financial Officer from March 2001 through January 10, 2010;
    he also served as HMA Senior Vice President of Finance.
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    Prior to the start of the class period, July 27, 2009, though January 9, 2012,
    HMA was a highly leveraged company confronting declining hospital admissions.
    After resignation of the former HMA Chief Operating Officer (“CEO”), the Board
    of Directors selected Newsome as President and CEO in September 2008. To
    improve revenue returns, Newsome told investors HMA would focus on three
    operational initiatives to improve the company’s financial performance: (1) the
    Emergency Department, (2) physician recruitment and development, and (3)
    market-service development. Plaintiffs-appellants allege HMA devised a corporate
    policy mandating unnecessary admission of Medicare patients to HMA hospitals to
    boost its financial position and stock price. Consequently, HMA admitted patients
    for observation, when they did not need to be admitted, and admitted inpatients,
    who should have been admitted for observation. 2
    Effective at the end of 2009, HMA upgraded the Pro-MED software used in
    the Emergency Departments of its hospitals. Pro-MED is a system to control
    physicians and increase patient admissions by ordering an extensive series of tests,
    many of which are unnecessary, when a patient enters an emergency room, thereby
    generating hospital revenue. By allegedly manipulating the Pro-MED system,
    2
    Plaintiffs-appellants obtained substantial information to support allegations in the second-
    amended, class-action complaint by interviewing former HMA employees as confidential
    witnesses at its various hospitals nationwide.
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    HMA ensured physicians would enter data to enable the system to recommend the
    emergency patient be admitted as an inpatient.
    HMA allegedly also pressed doctors to admit more Medicare patients,
    whose costs were guaranteed. 3 It hired outside consultants to review case files and
    to apply pressure on its physicians to increase admissions, regardless of medical
    necessity. In addition to admitting improperly patients, who arrived through the
    Emergency Department, HMA allegedly unnecessarily admitted patients, who
    arrived at the hospital for scheduled visits, and coded them as inpatients.
    In May or June 2011, HMA hired Accretive Health, which provides services
    to help healthcare providers generate sustainable improvements in their operating
    margins and healthcare quality. HMA had Accretive Health review patient
    information and pressure physicians to admit observation patients as inpatients.
    Because the cost per review of a patient file by Accretive Health was
    approximately $210, HMA determined only files of Medicare patients and possible
    surgery patients not admitted as inpatients were sent to Accretive Health for
    review.
    3
    Physicians were pressured to admit patients improperly to meet admission quotas set by the
    HMA corporate office. A confidential witness reported that HMA administrators were
    concerned, when the admission rate was below 20-22% each day. HMA sent to every HMA
    hospital daily reports, which contained patient-observation information, including the number of
    patient observations versus inpatient admissions, patient account numbers, and billing rates.
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    HMA ignored reports of improper patient admissions, including reports
    made by Paul Meyer, a former agent with the Federal Bureau of Investigation and
    former HMA Director of Compliance, who was tasked with ascertaining whether
    specific HMA hospitals complied with applicable federal and state laws as well as
    internal policies. In January 2010, Meyer discovered serious compliance issues
    involving Medicare billing practices at many HMA hospitals. In the first half of
    2010, Meyer warned HMA that several of its hospitals had secured higher
    government Medicare payments for elderly and disabled patients by fraudulently
    billing Medicare for patients improperly admitted as inpatients. When Meyer’s
    compliance concerns were unaddressed and uncorrected by HMA, he advised his
    supervisor in August 2010 he was going to prepare a detailed memorandum
    describing his observations for review by HMA top management and Board of
    Directors. Meyer’s supervisor required him to submit his memorandum to in-
    house counsel and to moderate it. Meyer was prohibited from listing CEO
    Newsome as a recipient and instructed by HMA counsel to destroy his drafts of the
    memorandum, which Meyer did not do.
    Meyer submitted his memorandum on August 19, 2010, to his supervisor,
    Mat Tormey, HMA Vice President of Compliance and Security, who reported
    directly to the Board of Directors and Newsome. Meyer additionally reported the
    fraudulent billing practices to Newsome. Rather than addressing the concerns in
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    Meyer’s memorandum, HMA removed Meyer’s oversight at hospitals identified in
    his memorandum and changed his job responsibilities. Shortly thereafter, HMA
    terminated his employment. On October 19, 2011, Meyer filed a whistleblower
    action against HMA. Other HMA employees faced termination for complaining or
    reporting on fraudulent billing practices.
    Plaintiffs-appellants allege the truth about the fraudulent practices for profit
    of HMA was revealed in various disclosing or revealing events. The first
    disclosure occurred on August 3, 2011, when HMA revealed it had received two
    subpoenas from the United States Department of Health and Human Services,
    Office of Inspector General (“OIG”). The subpoenas sought information related to
    Emergency Department management and the use of Pro-MED software by HMA.
    Following disclosure of the subpoenas, HMA stock declined in value and was
    downgraded by Wall Street analysts; HMA common stock declined by 9.12%. On
    October 25, 2011, HMA disclosed in its form 10-Q the subpoenas might be related
    to violations of the Anti-Kickback Statute and False Claims Act and could have
    resulted from a whistleblower complaint, the details of which HMA had withheld.
    On November 16, 2011, Richard W. Clayton III, Research Director at CtW
    Investment Group, sent a letter to Kent P. Dauten, Chairman of the HMA Audit
    Committee, and informed him HMA admissions rates far exceeded those that
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    could be explained by patient acuity or hospital geography. CtW estimated the
    excess admissions generated $40 million in excess Medicare billing in 2009, 25%
    of the net income for that year. Following the revelation of Meyer’s lawsuit, CtW
    sent a second letter on January 17, 2012, and noted Meyer’s allegations comported
    with its findings.
    On January 9, 2012, equity analyst Sheryl Skolnick of CRT issued a report
    (“2012 Skolnick Report”) informing the market of the wrongful termination
    lawsuit filed by Meyer (the “Meyer action”). With this disclosure, the price of
    HMA common stock declined more than 7% with an abnormal amount of shares
    traded. The following day, HMA revealed Timothy R. Parry, Senior Vice
    President, General Counsel, and Secretary had resigned effective immediately.
    The same day, HMA stock fell an additional 13% with more than sixty-eight
    million shares traded.
    On July 30, 2012, plaintiffs-appellants filed an amended complaint, alleging
    HMA had violated the Exchange Act during the Class Period.4 They alleged HMA
    concealed from investors it had engaged in a scheme to defraud Medicare by
    improperly admitting and billing patients for unnecessary emergency treatment.
    HMA moved to dismiss and argued the amended complaint failed to allege
    4
    Plaintiff-appellant New England Teamsters & Trucking Industry Pension Fund was the court-
    appointed lead plaintiff.
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    sufficiently the requisite falsity, scienter, and loss causation elements of a § 10(b)
    claim under the Exchange Act, as required by the Private Securities Litigation
    Reform Act of 1995 (“PSLRA”).
    On December 2, 2012, CBS aired a 60 Minutes segment focusing on HMA
    patient admissions and billing practices. After interviewing over a hundred current
    and former employees, the program detailed how HMA pressured its physicians to
    admit patients, who should not have been admitted, to generate higher Medicare
    revenue, set admissions quotas that could not have been met in the absence of
    fraud, and customized its Pro-MED computer to justify improper admission of
    more patients. The segment linked the admissions procedures directly to
    Newsome’s arrival through the testimony of a former HMA Executive Vice
    President.
    The day after this 60 Minutes segment aired, December 3, 2012, the CRT
    Capital Group LLC published a 161-page report, showing how HMA admission
    rates changed dramatically after Newsome became CEO. The report compared
    HMA hospitals during the 2006-to-2010 period to local competitors in the same
    state and concluded HMA had a high number of short stays and a low observation
    rate. The CRT report further determined the HMA troubling admission patterns
    occurred after its management had changed.
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    While the HMA motion to dismiss the first-amended complaint was
    pending, plaintiffs-appellants sought and received leave to file the subject second-
    amended complaint. Filed on February 25, 2013, the second-amended complaint
    included facts revealed during the 60 Minutes investigation of HMA patient
    admissions and billing practices to increase its revenues. HMA again moved to
    dismiss, based on failure to allege adequately falsity, scienter, and loss causation,
    required by the PSLRA. In his May 21, 2014, opinion and order, the district judge
    granted the HMA motion to dismiss plaintiffs-appellants’ second-amended, class-
    action complaint, because plaintiffs-appellants had failed to plead loss causation
    adequately. Plaintiffs-appellants timely appealed.
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    II. DISCUSSION
    A. Statutory and Pleading Requirements
    In this class action, plaintiffs-appellants allege HMA and three of its
    executives violated § 10(b) of the Exchange Act 5 and Rule 10b-56 by failing to
    disclose the fraudulent scheme of HMA to increase its Medicare revenue. To state
    a claim for securities fraud under § 10(b) and Rule 10b-5, a plaintiff must allege
    adequately:
    5
    Section 10(b) of the Exchange Act provides:
    It shall be unlawful for any person, directly or indirectly, . . . [t]o use or employ,
    in connection with the purchase or sale of any security . . . any manipulative or
    deceptive device or contrivance in contravention of such rules and regulations as
    the Commission may prescribe as necessary or appropriate in the public interest
    or for the protection of investors.
    15 U.S.C. § 78j(b).
    6
    Rule 10b–5, promulgated by the SEC pursuant to § 10(b), provides in relevant part:
    It shall be unlawful for any person, directly or indirectly, . . . [t]o make any untrue
    statement of a material fact or to omit to state a material fact necessary in order to
    make the statements made, in the light of the circumstances under which they
    were made, not misleading . . . .
    
    17 C.F.R. § 240
    .10b–5(b).
    Plaintiffs-appellants also bring a control-person claim under § 20(a) of the Exchange Act.
    Section 20(a) liability derives from liability under § 10(b); an examination of their § 20(a) claim
    necessarily requires a finding of § 10(b) liability. See Thompson v. RelationServe Media, Inc.,
    
    610 F.3d 628
    , 635–36 (11th Cir. 2010). Since there was no § 10(b) liability, there is no
    derivative liability on which to base a § 20(a) claim, and we need not address it. See Laperriere
    v. Vesta Ins. Grp., Inc., 
    526 F.3d 715
    , 721 (11th Cir. 2008) (per curiam) (noting § 20(a)
    “unambiguously imposes derivative liability on persons that control primary violators of the
    Act”).
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    (1) a material misrepresentation or omission; (2) scienter—a wrongful
    state of mind; (3) a connection between the misrepresentation and the
    purchase or sale of a security; (4) reliance, “often referred to in cases
    involving public securities markets (fraud-on-the-market cases) as
    transaction causation”; (5) economic loss; and (6) “loss causation, i.e.,
    a causal connection between the material misrepresentation and the
    loss.”
    Meyer v. Greene, 
    710 F.3d 1189
    , 1194 (11th Cir. 2013) (quoting Dura Pharms.,
    Inc. v. Broudo, 
    544 U.S. 336
    , 341-42, 
    125 S. Ct. 1627
    , 1631 (2005)).
    We review a district judge’s dismissal of a complaint de novo and accept all
    well-pleaded facts as true, construing them most favorably to the nonmoving party.
    World Holdings, LLC v. Fed. Republic of Germany, 
    701 F.3d 641
    , 649 (11th Cir.
    2012). Nonetheless, “[f]actual allegations that are merely consistent with a
    defendant’s liability fall short of being facially plausible.” Chaparro v. Carnival
    Corp., 
    693 F.3d 1333
    , 1337 (11th Cir. 2012) (citations and internal quotation
    marks omitted). An action alleging securities fraud is subject to the heightened
    pleading requirements of Federal Rule of Civil Procedure 9(b), which requires a
    complaint “to state with particularity the circumstances constituting fraud.” Fed.
    R. Civ. P. 9(b); Mizzaro v. Home Depot, Inc., 
    544 F.3d 1230
    , 1237 (11th Cir.
    2008). “The particularity requirement of Rule 9(b) is satisfied if the complaint
    alleges facts as to time, place, and substance of the defendant’s alleged fraud,
    specifically the details of the defendants’ allegedly fraudulent acts, when they
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    occurred, and who engaged in them.” United States ex rel. Matheny v. Medco
    Health Solutions, Inc., 
    671 F.3d 1217
    , 1222 (11th Cir. 2012) (citations and internal
    quotation marks omitted).
    In addition, the PSLRA provides for Rule 10b-5 claims predicated on
    allegedly false or misleading statements or omissions: “the complaint shall specify
    each statement alleged to have been misleading, the reason or reasons why the
    statement is misleading, and, if an allegation regarding the statement or omission is
    made on information and belief, the complaint shall state with particularity all facts
    on which that belief is formed.” 15 U.S.C. § 78u-4(b)(1). “[F]or all private Rule
    10b-5 actions requiring proof of scienter, ‘the complaint shall, with respect to each
    act or omission alleged to violate this chapter, state with particularity facts giving
    rise to a strong inference that the defendant acted with the required state of mind
    [i.e., scienter].’” FindWhat Investor Grp. v. FindWhat.com, 
    658 F.3d 1282
    , 1296
    (11th Cir. 2011) (quoting 15 U.S.C. § 78u-4(b)(2)) (first alteration added). The
    complaint also must allege facts supporting a strong inference of scienter “for each
    defendant with respect to each violation.” Phillips v. Scientific-Atlanta, Inc., 
    374 F.3d 1015
    , 1016 (11th Cir. 2004).
    The district judge found plaintiffs-appellants had satisfied the PSLRA
    heightened pleading requirements, because “the factual allegations, when accepted
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    as true, plausibly state with the requisite particularity the securities fraud claims.”
    Order Dismissing Second Amended Complaint at 32. He also determined
    plaintiffs-appellants had “sufficiently plead the false and misleading statements” to
    show material misrepresentations, 
    id.,
     based on particularized allegations “HMA
    led the peer group in admissions because of the fraudulent admission of Medicare
    patients, not the success of the Emergency Department initiatives,” id. at 33. The
    judge further concluded, “[b]ecause Newsome put the source of HMA’s success at
    issue, the alleged failure to disclose the true source of this revenue could give rise
    to liability under § 10(b),” evidencing plaintiffs-appellants “h[ad] sufficiently
    alleged that defendants made false and misleading statements.” Id. at 34. Noting
    “allegations of the aggressive admission policies initiated by Newsom, the
    individual defendants’ heavy involvement in daily operations, the upgrade of the
    Pro-MED software, and the use of Accretive Health, the amount and widespread
    nature of the fraud, the allegations in the Meyer [whistleblower] action, and the
    investigation by the OIG,” the judge concluded these “allegations, when viewed
    holistically, create a strong inference of scienter.” Id. at 36. We agree with the
    district judge’s analysis regarding the second-amended complaint as to
    particularity, material misrepresentation, and scienter reflected in the purchase and
    sale of HMA stock.
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    But the judge reasoned the OIG investigation, without disclosure of actual
    wrongdoing, did not qualify as a corrective disclosure, in accordance with our
    Meyer decision. The judge also determined the Meyer whistleblower case and the
    2012 Skolnick Report, summarizing the facts of that lawsuit, could not qualify as
    a corrective disclosure, because the Meyer case did not establish the falsity of any
    prior statements, and the Skolnick Report was nothing more than a restatement of
    information that already was public. Therefore, the determinative factor for the
    district judge and before this court is whether plaintiffs-appellants’ adequately
    alleged loss causation. 7
    7
    Plaintiffs-appellants reference the materialization-of-concealed-risk theory of loss
    causation. This court “has never decided whether the materialization-of-concealed-risk theory
    may be used to prove loss causation in a fraud-on-the-market case,” and we do not do so now,
    because loss causation is sufficient to resolve this case. Hubbard v. BankAtlantic Bancorp, Inc.,
    
    688 F.3d 713
    , 726 n.25 (11th Cir. 2012). In their complaint, plaintiffs-appellants allege HMA
    created a risk that, absent its fraudulent conduct, revenues and admissions would decline. But
    plaintiffs-appellants fail to allege adequately how this risk materialized and caused harm to
    HMA shareholders.
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    B. Fraud on the Market and Loss Causation
    “A ‘fraud on the market’ occurs when a material misrepresentation is
    knowingly disseminated to an informationally efficient market.” FindWhat, 
    658 F.3d at
    1310 (citing Basic Inc. v. Levinson, 
    485 U.S. 224
    , 247, 
    108 S. Ct. 978
    , 991-
    92 (1988)). In a § 10(b) lawsuit, a plaintiff must show proof of reliance on the
    alleged misrepresentation. Erica P. John Fund, Inc. v. Halliburton Co., 
    131 S. Ct. 2179
    , 2184 (2011). Fraud-on-the-market theory relies on the “efficient market
    hypothesis, which provides . . . that ‘in an open and developed securities market,
    the price of a company’s stock is determined by the available material information
    regarding the company and its business.’” FindWhat, 
    658 F.3d at 1309-10
    (quoting Basic, 
    485 U.S. at 241
    , 
    108 S. Ct. at 989
    ). An efficient market transmits
    information efficiently to prove reliance as well as to prove loss causation. Meyer,
    710 F.3d at 1198-99. Fraud-on-the-market theory in class-action, securities-fraud
    cases creates a rebuttable presumption of reliance, provided the misstatement was
    material, and the market was informationally efficient. FindWhat, 
    658 F.3d at
    1310 (citing Basic, 
    485 U.S. at 247
    , 
    108 S. Ct. 978
    , 991-92). Plaintiffs-appellants
    argue the efficient-market hypothesis to establish a presumption of reliance.
    Disclosure of information known by the market, confirmatory information,
    will not cause a change in stock price, because that information already has been
    assimilated by the market and incorporated in the stock price. 
    Id.
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    If and when the misinformation is finally corrected by the release of
    truthful information (often called a “corrective disclosure”), the
    market will recalibrate the stock price to account for this change in
    information, eliminating whatever artificial value it had attributed to
    the price. That is, the inflation within the stock price will “dissipate.”
    
    Id.
     But merely showing a security was purchased at a price that was artificially
    inflated by a fraudulent misrepresentation is insufficient. Hubbard v. BankAtlantic
    Bancorp, Inc., 
    688 F.3d 713
    , 725 (11th Cir. 2012).
    “[I]n a fraud-on-the-market case, the plaintiff must prove not only that a
    fraudulent misrepresentation artificially inflated the security’s value but also that
    ‘the fraud-induced inflation that was baked into the plaintiff’s purchase price was
    subsequently removed from the stock’s price, thereby causing losses to the
    plaintiff.’” 
    Id.
     (quoting FindWhat, 
    658 F.3d at 1311
    ). Consequently, § 10(b) “is
    not a prophylaxis against the normal risks attendant to speculation and investment
    in the financial markets” and only protects against loses attributable to a given
    misrepresentation. Meyer, 710 F.3d at 1196.
    Plaintiffs frequently demonstrate loss causation in fraud-on-the-
    market cases circumstantially, by: (1) identifying a “corrective
    disclosure” (a release of information that reveals to the market the
    pertinent truth that was previously concealed or obscured by the
    company’s fraud); (2) showing that the stock price dropped soon after
    the corrective disclosure;      and (3) eliminating other possible
    explanations for this price drop, so that the factfinder can infer that it
    is more probable than not that it was the corrective disclosure—as
    opposed to other possible depressive factors—that caused at least a
    “substantial” amount of the price drop.
    FindWhat, 
    658 F.3d at 1311-12
     (footnote omitted).
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    A corrective disclosure reveals the falsity of a previous representation to the
    market. Meyer, 710 F.3d at 1197 (citing Lentell v. Merrill Lynch & Co., 
    396 F.3d 161
    , 175 n.4 (2d Cir. 2005)); see FindWhat, 
    658 F.3d at
    1311 n.28. “To be
    corrective, a disclosure need not precisely mirror the earlier misrepresentation, but
    it must at least relate back to the misrepresentation and not to some negative
    information about the company.” 
    Id.
     (citation, internal quotation marks, and
    alteration omitted). A corrective disclosure can be established by a series of
    cumulative, partial disclosures. Id.; see Lormand v. U.S. Unwired, Inc., 
    565 F.3d 228
    , 261 (5th Cir. 2009). Plaintiffs-appellants allege the combination of two
    partial disclosures—the OIG investigation and the 2012 Skolnick Report—
    constitutes a corrective disclosure for the purpose of establishing loss causation.
    C. Failure to Plead Loss Causation Adequately
    “‘[L]oss causation analysis in a fraud-on-the-market case focuses on the
    following question: even if the plaintiffs paid an inflated price for the stock as a
    result of the fraud, (i.e., even if the plaintiffs relied), did the relevant truth
    eventually come out and thereby cause the plaintiffs to suffer losses?’” Meyer, 710
    F.3d at 1197 (quoting FindWhat, 
    658 F.3d at 1312
    ). The market may react
    negatively to the disclosure of an investigation, because it “can be seen to portend
    an added risk of future corrective action.” Id. at 1201. An adverse market
    reaction, however, does not establish the disclosure of an investigation constitutes
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    a corrective disclosure; further allegations are required to establish that previous
    statements were “false or fraudulent.” Id. New information is necessary to show
    loss causation, because “the market price of shares traded on well-developed
    markets reflects all publicly available information.” Basic Inc., 
    485 U.S. at 246
    ,
    
    108 S. Ct. at 991
    .
    “[B]ecause a corrective disclosure must reveal a previously concealed truth,
    it obviously must disclose new information, and cannot be merely confirmatory.”
    FindWhat, 
    658 F.3d at
    1311 n.28. We held in Meyer that an SEC investigation,
    like the OIG investigation in this case, “without more, is insufficient to constitute a
    corrective disclosure for purposes of § 10(b).” Meyer, 710 F.3d at 1201.
    Revelation of the OIG investigation, including issuance of subpoenas, does not
    show any actual wrongdoing and cannot qualify as a corrective disclosure.
    Plaintiffs-appellants contend the subsequent 2012 Skolnick Report,
    combined with the OIG investigation, together provided sufficient evidence of a
    corrective disclosure to cause an adverse market response and satisfied the
    requirements of Meyer. The Meyer whistleblower case, the basis of the 2012
    Skolnick Report, was not proof of fraud, because a civil suit is not proof of
    liability. Like the Einhorn Presentation in Meyer, the 2012 Skolnick Report
    summarized facts from the Meyer case that had existed in publicly accessible court
    dockets for three months before the Skolnick Report issued. While we may
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    “countenance some lag” in the capacity of the market to digest publically available
    information, the Meyer action was publicly available and the impetus for the 2012
    Skolnick Report. Id. at 1198 n.9. Consequently, the information first revealed by
    the Meyer action and summarized in the 2012 Skolnick Report was easily
    obtainable, and the market was able to assimilate the information without the
    assistance of the 2012 Skolnick Report. See Pub. Emps. Ret. Sys. of Miss. v.
    Amedisys, Inc., 
    769 F.3d 313
    , 323 (5th Cir. 2014) (noting “complex economic data
    understandable only through expert analysis may not be readily digestible by the
    marketplace” and analysis of that data may not be merely confirmatory); In re
    Gilead Scis. Sec. Litig., 
    536 F.3d 1049
    , 1058 (9th Cir. 2008) (determining a three-
    month delay between a disclosure and a price drop did not break the causal chain
    for loss causation where physicians, but not the general public, would be
    responsive to the content of a Federal Drug Administration warning letter, and the
    market did not respond until financial disclosures were made).
    “[T]he mere repackaging of already-public information by an analyst or
    short-seller is simply insufficient to constitute a corrective disclosure.” Meyer, 710
    F.3d at 1199 (citing cases holding opinions and analyses of publicly available
    information are not corrective disclosures). The lack of new information in the
    2012 Skolnick Report is “fatal to the [plaintiffs-appellants’] claim of loss
    causation.” Id. at 1198 (citing FindWhat, 
    658 F.3d at
    1311 n.28). If an analyst’s
    20
    Case: 14-12838     Date Filed: 05/11/2015    Page: 21 of 31
    report, such as the 2012 Skolnick Report, “based on already-public information
    could form the basis for a corrective disclosure, then every investor who suffers a
    loss in the financial markets could sue under § 10(b) using an analyst’s negative
    analysis of public filings as a corrective disclosure.” Id. at 1199.
    Plaintiffs-appellants’ allegations show only there was an OIG investigation,
    a whistleblower lawsuit the market disregarded, and a negative summary of
    already public information. Taken independently or combined, they are inadequate
    to establish the falsity of HMA disclosures. Neither the OIG investigation nor the
    2012 Skolnick Report are corrective disclosures, establishing a causal link for
    plaintiffs-appellants’ stock-value loss. After three attempts at drafting complaints,
    the district judge correctly decided plaintiffs-appellants had failed to allege
    adequately loss causation to establish their securities-fraud class action and
    dismissed their case with prejudice.
    AFFIRMED.
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    Case: 14-12838     Date Filed: 05/11/2015   Page: 22 of 31
    Martin, Circuit Judge, concurring in judgment only:
    I agree that we must affirm the District Court’s dismissal of the plaintiffs’
    complaint for failure to plead loss causation. Under our binding precedent in
    Meyer v. Greene, 
    710 F.3d 1189
     (11th Cir. 2013), plaintiffs must be armed with
    proof of a misrepresentation in order to plead securities fraud. Applying that rule,
    these plaintiffs cannot satisfy the loss causation pleading requirements by showing
    that Health Management Associates’ stock price fell immediately after the
    disclosure of a whistle-blower complaint alleging Medicare fraud and the
    announcement of a government investigation into HMA’s Medicare billing
    practices because neither the complaint nor the investigation revealed actual
    wrongdoing. 
    Id.
     at 1201 & n.13.
    I believe Meyer was wrongly decided. To require a conclusive finding of
    fraud at the pleadings stage imposes a prohibitive burden on plaintiffs and
    immunizes defendants who have successfully concealed their misconduct from the
    government. In my view, fully embracing Meyer’s logic would extinguish the
    ability of private actions to serve as an independent check on market integrity. Cf.
    Tellabs, Inc. v. Makor Issues & Rights, Ltd., 
    551 U.S. 308
    , 313, 
    127 S. Ct. 2499
    ,
    2504 (2007) (“This Court has long recognized that meritorious private actions to
    enforce federal antifraud securities laws are an essential supplement to criminal
    prosecutions and civil enforcement actions brought, respectively, by the
    22
    Case: 14-12838       Date Filed: 05/11/2015       Page: 23 of 31
    Department of Justice and the Securities and Exchange Commission (SEC).”). I
    write separately to explain why I believe that Meyer is contrary to Supreme Court
    precedent.
    I.
    As the majority opinion sets out, in order to state a claim for securities fraud
    under Section 10(b) of the Securities Exchange Act of 1934 and Securities and
    Exchange Commission Rule 10(b)–5, plaintiffs must allege the following six
    elements: (1) a material misrepresentation or omission; (2) scienter; (3) a
    connection between the misrepresentation and the purchase or sale of a security;
    (4) reliance; (5) economic loss; and (6) loss causation. 1 Dura Pharms., Inc. v.
    Broudo, 
    544 U.S. 336
    , 341–42, 
    125 S. Ct. 1627
    , 1631 (2005).
    Loss causation is similar to the concept of proximate cause in tort. It
    requires that plaintiffs establish a causal link between a defendant’s misconduct
    and the economic loss that they have suffered. The Supreme Court most recently
    addressed the standards for both pleading and proving loss causation in Dura
    Pharmaceuticals, Inc. v. Broudo. Specifically, the Supreme Court reversed the
    Ninth Circuit’s holding that plaintiffs could satisfy the loss causation requirement
    1
    And as the majority opinion also makes clear, the pleading requirements for securities
    fraud lawsuits are stringent. In order to survive a motion to dismiss, a claim brought under Rule
    10b–5 must satisfy (1) the federal notice pleading requirements, (2) the special fraud pleading
    requirements provided by Federal Rule of Civil Procedure 9(b), and (3) the additional pleading
    requirements imposed by the Private Securities Litigation Reform Act (PSLRA).
    23
    Case: 14-12838     Date Filed: 05/11/2015    Page: 24 of 31
    simply by alleging, and subsequently proving, that they had purchased a security at
    an artificially inflated price. Dura, 
    544 U.S. at 342
    , 
    125 S. Ct. at 1631
    .
    The Supreme Court explained that the Ninth Circuit’s standard was both
    illogical and inconsistent with the common-law roots of private securities fraud
    actions: at the moment that an investor purchases a security at an artificially
    inflated price, she has not yet suffered any loss. See 
    id.
     Further, if the price of the
    security later falls for a reason wholly unrelated to the defendant’s misconduct (for
    example, a market-wide crash), the investor also cannot recover. 
    Id.
     at 342–43,
    
    125 S. Ct. at
    1631–32. Instead, plaintiffs must “prove that the defendant’s
    misrepresentation (or other fraudulent conduct) proximately caused [their]
    economic loss.” 
    Id. at 346
    , 
    125 S. Ct. at 1633
    .
    After explaining what was required as a matter of proof, the Supreme Court
    next turned to the pleading requirements for loss causation. It first observed that,
    consistent with Federal Rule of Civil Procedure 8(a)(2), a complaint need only
    provide the defendant with “fair notice of what the plaintiff’s claim is and the
    grounds upon which it rests.” 
    Id. at 346
    , 
    125 S. Ct. at 1634
     (quotation marks
    omitted). Although the complaint in Dura was found to be insufficient because it
    stated only that the plaintiffs had suffered a loss by purchasing securities at
    artificially inflated prices, the Supreme Court suggested that the complaint would
    have been adequate had it stated that Dura’s stock price fell after the alleged
    24
    Case: 14-12838   Date Filed: 05/11/2015    Page: 25 of 31
    misrepresentations had been exposed. 
    Id. at 347
    , 
    125 S. Ct. at 1634
    . The Supreme
    Court ended its discussion by noting that the standard for pleading loss causation
    was a “simple test” and that “it should not prove burdensome for a plaintiff who
    has suffered an economic loss to provide a defendant with some indication of the
    loss and the causal connection that the plaintiff has in mind.” 
    Id.
     at 346–47, 
    125 S. Ct. at 1634
    .
    Following Dura, we have held that plaintiffs can prove loss causation
    circumstantially, by:
    (1) identifying a “corrective disclosure” (a release of information that
    reveals to the market the pertinent truth that was previously concealed
    or obscured by the company’s fraud); (2) showing that the stock price
    dropped soon after the corrective disclosure; and (3) eliminating other
    possible explanations for this price drop, so that the factfinder can
    infer that it is more probable than not that it was the corrective
    disclosure—as opposed to other possible depressive factors—that
    caused at least a “substantial” amount of the price drop.
    FindWhat Investor Grp. v. FindWhat.com, 
    658 F.3d 1282
    , 1311–12 (11th Cir.
    2011).
    Thus, the corrective disclosure mirrors the misrepresentation—just as the
    misrepresentation artificially pushes the price of a stock up, the corrective
    disclosure removes “the fraud-induced inflation that was baked into the plaintiff’s
    purchase price, thereby causing losses to the plaintiff.” 
    Id. at 1311
    . Although
    Dura did not set forth any requirements about the quality, form, or precision of a
    corrective disclosure, we have held that “a corrective disclosure can come from
    25
    Case: 14-12838     Date Filed: 05/11/2015    Page: 26 of 31
    any source, and can take any form from which the market can absorb the
    information and react.” 
    Id.
     at 1312 n.28 (alterations adopted and quotation
    omitted). Plaintiffs also do not need to prove that a single piece of information
    precisely and conclusively refuted the defendant’s misrepresentations. Instead,
    they may establish loss causation by showing that fraud was gradually revealed
    through a series of “partial disclosures.” Meyer, 710 F.3d at 1197 (quotation
    omitted); see also Dura, 
    544 U.S. at 342
    , 
    125 S. Ct. at 1631
     (observing that the
    truth about a security’s value may “leak out” into the marketplace).
    II.
    With that background in mind, I turn to Meyer v. Greene, our Court’s most
    recent attempt at defining loss causation’s pleading requirements. In Meyer, the
    plaintiffs alleged that a developer misrepresented the value of its real estate
    holdings. 710 F.3d at 1193. Under their loss causation theory, the true value of
    the developer’s stock was revealed through three partial disclosures, each of which
    caused the security’s price to decline: (1) a hedge fund analyst’s presentation
    which used previously available information to conclude that the developer’s
    holdings were overvalued; (2) the developer’s disclosure of an informal SEC
    investigation into whether the developer had complied with federal securities laws;
    and (3) the developer’s disclosure of a formal SEC investigation into that same
    subject matter. Id. at 1197, 1201.
    26
    Case: 14-12838      Date Filed: 05/11/2015       Page: 27 of 31
    Relying primarily on past Eleventh Circuit precedent that discussed what
    was needed to prove loss causation,2 the panel concluded that the plaintiffs had
    failed to adequately plead loss causation. The panel rejected the argument that the
    hedge fund analyst’s presentation qualified as a corrective disclosure because the
    presentation simply “repackaged” already available data and therefore, did not
    reveal anything that had been previously concealed. Id. at 1199.
    It also reasoned that the announcements of the government investigation
    could not serve as corrective disclosures—even though the investigation concerned
    precisely the same subject matter as the alleged fraud and caused the developer’s
    stock price to fall—because the SEC had not yet issued a finding of wrongdoing.
    Id. at 1201. Thus, the investigation did not “reveal to the market that a company’s
    previous statements were false or fraudulent.” Id. The panel left open the
    possibility that the announcement of government investigations could potentially
    form the basis for a corrective disclosure, but only if there were a later finding of
    actual fraud. See id. n.13 (“It may be possible, in a different case, for the
    disclosure of an SEC investigation to qualify as a partial corrective disclosure for
    purposes of opening the class period when the investigation is coupled with a later
    finding of fraud or wrongdoing.”).
    2
    For example, in Hubbard v. BankAtlantic Bancorp, Inc., 
    688 F.3d 713
     (11th Cir. 2012),
    we considered an appeal following a motion for judgment as a matter of law following a jury
    trial, and in FindWhat Investor Group v. FindWhat.com, 
    658 F.3d 1282
     (11th Cir. 2011), we
    considered an appeal from the grant of a motion for summary judgment.
    27
    Case: 14-12838     Date Filed: 05/11/2015    Page: 28 of 31
    Meyer’s reasoning would have made good sense in evaluating whether the
    plaintiffs had met their burden of proof. It is clear that plaintiffs must prove the
    existence of a misrepresentation before their losses become compensable. But
    holding plaintiffs to this standard at the pleadings stage is contrary to both
    precedent and logic.
    Dura tells us that because pleading rules are “not meant to impose a great
    burden,” a plaintiff need only provide defendants with “some indication of the loss
    and the causal connection that the plaintiff has in mind.” 
    544 U.S. at 347
    , 
    125 S. Ct. at 1634
    . Meyer requires far more. By holding that plaintiffs must possess a
    conclusive finding of wrongdoing before even being able to plead securities fraud,
    we now force inquiry into plaintiffs’ proof at the pleadings stage. Cf. Bell Atl.
    Corp. v. Twombly, 
    550 U.S. 544
    , 556, 
    127 S. Ct. 1955
    , 1965 (2007) (observing
    that a well-pleaded complaint may proceed even if “recovery is very remote and
    unlikely” (quotation marks omitted)).
    Beyond these problems, Meyer’s suggestion that the initial announcement of
    an investigation could potentially serve as a corrective disclosure if coupled with a
    later government finding of wrongdoing, see 710 F.3d at 1201 & n.13, evinces a
    fundamental misunderstanding of loss causation. The requirement for a corrective
    disclosure serves the purpose of ensuring that plaintiffs meet the traditional
    common-law requirement of proximate cause. Dura, 
    544 U.S. at 347
    , 
    125 S. Ct. at
    28
    Case: 14-12838     Date Filed: 05/11/2015    Page: 29 of 31
    1634. Consistent with this purpose, we have reasoned that if the price of a security
    falls soon after the release of new information, then courts can infer that this new
    information proximately caused economic loss. See FindWhat, 
    658 F.3d at
    1311–
    12. What is important, then, is the market’s reaction to a purported corrective
    disclosure at the time that the disclosure was made. See Bricklayers & Trowel
    Trades Int’l Pension Fund v. Credit Suisse Sec. (USA) LLC, 
    752 F.3d 82
    , 86 (1st
    Cir. 2014) (observing that an event study, which is a statistical analysis of the
    change in a security’s value in response to new information, is the “preferred”
    method for proving loss causation).
    However, Meyer implies that this causal chain is somehow affected by the
    government’s later finding of actual fraud. This defies logic. A later finding
    cannot change how the market reacted to an announcement at an earlier time. The
    government’s finding of fraud goes instead to the plaintiff’s ability to prove
    misrepresentation—an entirely different element of her claim.
    Finally, by evaluating each of the three disclosures individually, Meyer
    failed to recognize that the plaintiffs in that case had pleaded a series of partial
    corrective disclosures through which the truth “beg[an] to leak out.” Dura, 
    544 U.S. at 342
    , 
    125 S. Ct. at 1631
    . Surely even if each disclosure standing alone was
    insufficient, the cumulative effect of the presentation and the announcements of the
    government investigations—all of which provided information about the
    29
    Case: 14-12838     Date Filed: 05/11/2015    Page: 30 of 31
    defendant’s allegedly fraudulent accounting practices and resulted in a decline in
    the stock price—created a “plausible causal relationship” between the alleged
    fraud and the plaintiffs’ economic loss. Lormand v. US Unwired, Inc., 
    565 F.3d 228
    , 258 (5th Cir. 2009) (quotation marks omitted).
    “To preclude [a] suit on the basis that there has been no previous actual
    disclosure of fraud . . . misses the mark.” In re Gentiva Sec. Litig., 
    932 F. Supp. 2d 352
    , 388 (E.D.N.Y. 2013). Recognizing the prohibitive burden that the Meyer rule
    imposes, a number of other courts have rejected the argument that the
    announcement of a government investigation into the same subject matter as the
    alleged fraud cannot be pled as a corrective disclosure. See, e.g., Pub. Emps. Ret.
    Sys. of Miss., 
    769 F.3d 313
    , 324–25 (5th Cir. 2014) (“To require, in all
    circumstances, a conclusive government finding of fraud merely to plead loss
    causation would effectively reward defendants who are able to successfully
    conceal their fraudulent activities by shielding them from civil suit.” (quotation
    omitted)); Gentiva, 932 F. Supp. 2d at 387 (“After this review of the authorities,
    ultimately, the Court rejects the idea that the disclosure of an investigation, absent
    an actual revelation of fraud, is not a corrective disclosure.”); In re IMAX Sec.
    Litig., 
    587 F. Supp. 2d 471
    , 485 (S.D.N.Y. 2008) (holding that the announcement
    of an SEC investigation into the same subject matter as the alleged
    30
    Case: 14-12838   Date Filed: 05/11/2015    Page: 31 of 31
    misrepresentations qualified as a corrective disclosure); Brumbaugh v. Wave Sys.
    Corp., 
    416 F. Supp. 2d 239
    , 256 (D. Mass. 2006) (same).
    III.
    The plaintiffs in this case allege that HMA artificially inflated its stock price
    by fraudulently overbilling Medicare. They have also alleged that they suffered
    economic loss because HMA’s stock price fell precipitously after the disclosure of
    a whistle-blower lawsuit describing Medicare fraud at HMA hospitals and a
    government investigation into the company’s Medicare billing practices. Taken
    together, these are precisely the allegations that Dura requires: the complaint
    provides both “notice of what the relevant economic loss might be” and “what the
    causal connection might be between that loss” and the alleged misrepresentations.
    
    544 U.S. at 347
    , 
    125 S. Ct. at 1634
    . Although I recognize that my conclusion is
    foreclosed by Meyer, I believe that plaintiffs have met their burden at this very
    early stage.
    31