Noreen Lanahan v. County of Cook

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 21-1852
NOREEN LANAHAN ,
Plaintiff-Appellant,
v.
C OUNTY OF C OOK,
Defendant-Appellee.
____________________
Appeal from the United States District Court for the
Northern District of Illinois, Eastern Division.
No. 17-cv-5829 — Harry D. Leinenweber, Judge.
____________________
A RGUED F EBRUARY 17, 2022 — DECIDED J ULY 20, 2022
____________________
Before R OVNER , HAMILTON , and S T. EVE, Circuit Judges.
ST. EVE, Circuit Judge. Relator Noreen Lanahan was a long-
time employee of Cook County’s Department of Public
Health responsible for managing federal grants. After her re-
tirement, Relator filed a qui tam suit against Cook County, al-
leging various violations of the False Claims Act arising out
of the use of federal grants. The district court dismissed Rela-
tor’s Second Amended Complaint with prejudice, and Relator
now appeals. We affirm.

-- 1 of 17 --

2 No. 21-1852
I. Background
Appellant Noreen Lanahan (“Relator”) worked as a direc-
tor of financial control in Cook County’s Department of Pub-
lic Health (“CCDPH”), a certified public health department,
from 1994 until her retirement in 2017. In this capacity, Rela-
tor oversaw Cook County’s claim and reimbursement policies
for hundreds of federal grants and crafted budgets submitted
to the federal government in order to qualify for grant fund-
ing. During this period, Cook County received approximately
$20 million annually from the federal government for services
related to federal public health priorities. Between 2008 and
2017, Relator repeatedly warned Cook County it was seeking
federal reimbursement for unincurred expenses. Relator iden-
tifies four examples of Cook County’s purportedly fraudulent
practices.
A. 2009–11 H1N1 Influenza Grant
In September 2009, the Centers for Disease Control and
Prevention (“CDC”) awarded Cook County $2.5 million in
federal grant funds to distribute the H1N1 vaccine. Prior to
performing under the grant, Cook County prepared an antic-
ipated budget. By regulation, Cook County could only be re-
imbursed for costs associated with work actually performed
under the grant. Instead, Relator asserts Cook County esti-
mated the time dedicated to federal service after the fact and
pinned the salary allocations submitted for reimbursement to
the CDC to pre-performance budget estimates. Relator herself
“never tracked [ ] federal service dedication,” never asked
other managers how they apportioned employee time and
was never solicited for an estimate of how individual employ-
ees apportioned their time among federal and local service.

-- 2 of 17 --

No. 21-1852 3
Indeed, Relator never tracked her own dedication to federal
service.
On September 1, 2011, Cook County submitted two Certi-
fied Grant Allocation Cost Reports, one associated with the
IDPH Pandemic Flu program and one with the IDPH Mass
Vaccination program. Although the line-item shared ex-
penses for each individual employee are identical, the IDPH
Pandemic Flu expense report requested $1,065,506.05 in fed-
eral reimbursement while the IDPH Mass Vaccination ex-
pense report requested $1,210,802.33 in federal reimburse-
ment. On September 26, 2011, the CDC transmitted reim-
bursement vouchers to the Cook County Comptroller.
Cook County was also required by regulation to segregate
federal reimbursement funds from unaffiliated Cook County
revenue. Upon receiving federal funds, Cook County submit-
ted credit vouchers to apply the reimbursements to accounts
in the CCDPH’s general ledger. On November 30, 2011, the
Cook County Comptroller moved the H1N1 funds into a dis-
cretionary account for the benefit of Cook County Health and
Hospital Systems (“CCHHS”). Relator asserts this transfer
“frustrated the allocations” in the September 1, 2011, report
and “undermined any truth to the budget and compliance
certifications” represented to qualify for and close out the
grants.
B. 2012–14 WIC Grant
The Supplemental Nutrition Assistance Program
(“SNAP”) for Women, Infants and Children (“WIC”) pro-
vides supplemental nutrition, education, and healthcare to
low-income citizens. Individual WIC grant business units oc-
casionally retain positive balances at the end of the fiscal year

-- 3 of 17 --

4 No. 21-1852
as a product of deferred personnel costs. By July 2014, Cook
County had accumulated approximately $6.8 million in de-
ferred WIC credits. In an email to Cook County’s Director of
Grants Management, Relator explained the $6.8 million “pro-
vides funding for Salaries and Fringe Benefits of grant em-
ployees should current grants not be renewed” and the “de-
ferred revenue rolls forward from the previous grant year and
is adjusted at grant closing.” To avoid “distort[ing] current
period grant expenses,” Relator opined the “funds need[ed]
to be segregated by the use of a unique Cost Center.” Instead,
Cook County opted to move the $6.8 million in deferred rev-
enue into the general health fund of the CCHHS as, according
to Cook County’s Chief Budget Officer, “[p]resumably these
are expenses that were absorbed by the general/health fund
when they occurred.” Relator asserts CCHHS did not itself
incur any expense in connection with the WIC grants.
C. Alleged Hektoen Kickback Scheme
The Hektoen Institute of Medicine (“Hektoen”) is a non-
profit fiscal agent that processes claims and collects reim-
bursement revenue on behalf of Cook County for personal
service costs incurred by Cook County physicians for federal
grants. Hektoen did not have a formal agreement with Cook
County but instead unofficially contracted with Cook County
physicians in an “Exhibit A” package. Hektoen retained the
only executed copies of these agreements, which Relator al-
leges violated recordkeeping regulations. Hektoen submits
claims upon and collects revenue from federal research grants
on behalf of Cook County physicians in exchange for 10–15%
of the awarded grant amount. Hektoen reallocated this col-
lected revenue into a ”Dean’s Fund” and gave physicians
“near autonomy” over the money.

-- 4 of 17 --

No. 21-1852 5
In 2015, Hektoen collected and retained $5 million in re-
stricted federal funds. Relator points to a 2018 Chicago Trib-
une article detailing allegations against Dr. Bala Hota, a for-
mer Cook County hospital physician, as an example of the
problems with Hektoen’s practices. Dr. Hota allegedly em-
bezzled almost $280,000 from Hektoen’s salary reallocation
account, which he spent on personal expenses such as iTunes,
luxury travel, and couture cupcakes.
D. 2009–12 PHIMC Grant Management
The Public Health Institute of Metropolitan Chicago
(“PHIMC”) is a nonprofit fiscal agent. PHIMC is not a certi-
fied health department. In 2010, the CDC awarded CCDPH
$15.9 million as an up-front payment for services to be ren-
dered during a two-year period of performance. In the fund-
ing notice, the CDC limited funding to certified public health
departments. The CCHHS Board approved PHIMC to serve
as the fiscal agent for these funds. In June 2011, the CCHHS
Board passed a resolution authorizing the transfer of grant
funds to PHIMC, even though Relator alleges it had trans-
ferred the funds previously. PHIMC lacked the resources and
financial controls to qualify for the award independently and
the CCDPH would have to account for the funds in an annual
audit.
E. Procedural History
Relator filed an initial qui tam complaint alleging various
violations of the False Claims Act (“FCA”), 31 U.S.C. § 3729 et
seq. After investigating Relator’s allegations, the United States
declined to intervene. Cook County moved to dismiss Rela-
tor’s complaint for failure to state a claim under Rule 12(b)(6)
and Rule 9(b). Instead of responding, Relator filed a First

-- 5 of 17 --

6 No. 21-1852
Amended Complaint which differed very little from the ini-
tial complaint. Cook County moved to dismiss the First
Amended Complaint under Rule 12(b)(6) and Rule 9(b) as
well.
The district court dismissed Relator’s First Amended
Complaint without prejudice in a thorough and detailed
opinion. The chief deficiencies of Relator’s FCA claims were
twofold. First, Relator failed to plead the submission of a false
statement to the government, and certainly not with the par-
ticularity required under Rule 9(b). Indeed, most of the activ-
ities Relator described occurred after federal payments had
been disbursed to Cook County. Second, Relator failed to al-
lege any false claim for payment submitted by Cook County
to the government. The district court observed accounting
failures, procedural irregularities, and regulatory violations
could not themselves give rise to an FCA claim.
In response, Relator filed the operative Second Amended
Complaint, alleging four causes of action under the FCA: a
claim for presenting false claims for payment, in violation of
31 U.S.C. § 3729(a)(1)(A) (Count I); a claim for use of false
statements, in violation of 31 U.S.C. § 3729(a)(1)(B) (Count II);
a claim for conversion, in violation of 31 U.S.C. § 3729(a)(1)(D)
(Count III); and a claim for reverse false claims, in violation of
31 U.S.C. § 3729(a)(1)(G) (Count IV). Again, Cook County
moved to dismiss the Second Amended Complaint based on
Rule 12(b)(6) and Rule 9(b).
The district court dismissed the Second Amended Com-
plaint with prejudice against Relator.1 The district court noted
1 Initially, the district court dismissed the Second Amended Complaint
with prejudice without specifying whether it pertained only to Relator or

-- 6 of 17 --

No. 21-1852 7
that, despite painstakingly explaining the Rule 9(b) pleading
standard in its previous opinion, Relator failed to cure the de-
ficiencies that warranted dismissal of the First Amended
Complaint. The defects that doomed the Second Amended
Complaint mirror those that doomed the First Amended
Complaint. Specifically, with respect to Count I and Count II,
Relator failed to adequately plead any false statements or
claims, let alone any false statements connected with any gov-
ernment payments. While Relator’s allegations surrounding
the administration of the H1N1 grant reimbursement were
more detailed, they nonetheless did not identify any specific
falsities in the reports Cook County submitted. Even had Re-
lator adequately pled a false statement, she did not link it to a
government payment. The district court deemed Relator’s im-
proper retention claims in Count III and Count IV inadequate
because the Second Amended Complaint did not contain suf-
ficient facts indicating Cook County had retained any funds
that properly belonged to the government. Because Relator
enjoyed two opportunities to amend her complaint, one with
the benefit of the district court’s detailed assessment of the
claims’ flaws, the district court dismissed the Second
Amended Complaint with prejudice. The district court ob-
served the Second Amended Complaint contained “the same
mistakes” as Relator’s previous iteration, and these deficien-
cies were “not small and provide th[e] Court with no indica-
tion that Relator may be able to adequately plead an FCA
claim in the future.” Relator now appeals the district court’s
to the United States as well. The district court granted the government’s
resultant motion to clarify the dismissal and specified the action was dis-
missed with prejudice as to Relator but without prejudice as to the United
States.

-- 7 of 17 --

8 No. 21-1852
order dismissing the Second Amended Complaint with prej-
udice.
II. Discussion
Relator presents two arguments on appeal.2 First, that the
district court improperly dismissed her suit for failure to state
a claim. Second, that the district court improperly did so with
prejudice. Both arguments fail.
The FCA imposes civil liability on a series of actions re-
lated to fraudulent treatment of government funds. 31 U.S.C.
§ 3729(a)(1). The Attorney General may bring suit under the
FCA directly in the name of the United States. Id. at § 3730(a).
Alternatively, a private citizen referred to as a “relator” may
bring a qui tam action “in the name of the Government.” Id. at
§ 3730(b)(1). If the qui tam action results in damages, the rela-
tor shares in the award. See id. at § 3730(d).
We review a district court’s dismissal of a complaint de
novo, construing “all allegations and any reasonable infer-
ences in the light most favorable to the plaintiff.” Jauquet v.
Green Bay Area Catholic Educ., Inc., 996 F.3d 802, 807 (7th Cir.
2021) (internal quotations omitted). Rule 12(b)(6) requires a
complaint contain sufficient facts “to state a claim to relief that
2 Although the district court did not enter a separate final judgment in this
case per Federal Rule of Civil Procedure 58, we are nonetheless confident
in our appellate jurisdiction. The district court clearly “indicated its intent
to finally dispose of all claims,” Law Offices of David Freydin, P.C. v.
Chamara, 24 F.4th 1122, 1128 (7th Cir. 2022), in dismissing the Second
Amended Complaint with prejudice, expressly noting the “deficiencies in
the [Second Amended Complaint] … provide this Court with no indica-
tion that Relator may be able to adequately plead an FCA claim in the fu-
ture.” The district court’s judgment is therefore final within the meaning
of 28 U.S.C. § 1291. See id.

-- 8 of 17 --

No. 21-1852 9
is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544,
570 (2007).
Claims arising under the FCA, an antifraud statute, are
subject to Rule 9(b)’s heightened pleading standard. United
States ex rel. Mamalakis v. Anesthetix Mgmt. LLC, 20 F.4th 295,
301 (7th Cir. 2021). To state such a claim, Relator “must state
with particularity the circumstances constituting fraud or
mistake.” Fed. R. Civ. P. 9(b). To satisfy Rule 9(b)’s strictures,
Relator must plead “the first paragraph of any newspaper
story,” i.e., the “who, what, when, where, and how of the
fraud.” United States ex rel. Berkowitz v. Automation Aids, Inc.,
896 F.3d 834, 839 (7th Cir. 2018) (internal quotations omitted).
None of Relator’s causes of action meet this rigorous pleading
standard.
A. Counts I–II: False Claims and False Statements
Relator’s first two causes of action both involve allegations
of false submissions to the government. Section 3729(a)(1)(A)
imposes civil liability where a person “knowingly presents, or
causes to be presented, a false or fraudulent claim for pay-
ment or approval” to the government. 31 U.S.C.
§ 3729(a)(1)(A). To maintain a cause of action under
§ 3729(a)(1)(A), Relator must plead with particularity (1) the
existence of a false or fraudulent claim that (2) Cook County
presented to the government for payment (3) with knowledge
the claim was false. United States v. Sanford-Brown, Ltd., 788
F.3d 696, 709 (7th Cir. 2015), reinstated in part, superseded in part
on other grounds by United States v. Sanford-Brown, Ltd., 840
F.3d 445 (7th Cir. 2016). Section 3729(a)(1)(B) prohibits
“knowingly mak[ing], us[ing], or caus[ing] to be made or
used, a false record or statement material to a false or fraudu-
lent claim.” To survive a motion to dismiss under this section,

-- 9 of 17 --

10 No. 21-1852
Relator must plead Cook County (1) made a statement in or-
der to receive money from the government, (2) the statement
was false, (3) Cook County knew the statement was false at
the time it made the statement, and (4) the statement was ma-
terial to the government’s decision to give Cook County
money. Berkowitz, 896 F.3d at 840.
Relator’s claims under § 3729(a)(1)(A) and § 3729(a)(1)(B)
falter at the first element. Relator has not alleged any false
claim or statement for payment with the degree of granularity
Rule 9(b) requires. Rule 9(b) demands Relator “allege … spe-
cific facts demonstrating what occurred at the individualized
transactional level” to maintain a claim. Id. at 841. This “in-
cludes ‘the identity of the person making the misrepresenta-
tion, the time, place, and content of the misrepresentation,
and the method by which the misrepresentation was commu-
nicated to the [defendant].’” United States ex rel. Hanna v. City
of Chi., 834 F.3d 775, 779 (7th Cir. 2016) (quoting United States
ex rel. Grenadyor v. Ukrainian Vill. Pharmacy, Inc., 772 F.3d 1102,
1106 (7th Cir. 2014)).
We dismiss outright Relator’s conclusory assertions that
Cook County profited from “reimbursement of WIC false
claims” and that Hektoen was reimbursed “[d]espite the fal-
sity of the underlying claims.” We are not obligated to accept
“sheer speculation, bald assertions, and unsupported conclu-
sory statements” on a motion to dismiss. Taha v. Int’l Bhd. of
Teamsters, Local 781, 947 F.3d 464, 469 (7th Cir. 2020). With re-
spect to Relator’s allegations regarding the WIC grant funds,
Hektoen, and PHIMC’s treatment of federal grant money, she
does not identify any statement or claim, false or otherwise,
Cook County made to the government. For each of these
sources of federal grant money, Relator objects only to Cook

-- 10 of 17 --

No. 21-1852 11
County’s treatment of the funds after they were disbursed.
The Second Amended Complaint is utterly silent as to the
events leading up to Cook County’s receipt of these funds.
Relator’s assertions of regulatory or contractual violations are
similarly incapable of establishing an FCA claim absent some
connection between the breaches and a false statement or
claim for payment, which Relator has not pleaded. See Berko-
witz, 896 F.3d at 839; Hanna, 834 F.3d at 779.
Relator’s assertions about the expense reports Cook
County submitted to the CDC for reimbursement under the
H1N1 vaccination grant provide some additional details, but
these, too, fail. Relator asserts generally that the expense re-
ports are false because the allocations were estimated after the
fact instead of recorded contemporaneously. Relator, how-
ever, does not support this claim with particularized infor-
mation about how the allocations were calculated or the ex-
pense reports prepared. Indeed, Relator states she “never dis-
cussed … how individual employees apportioned their time
among various federal and local services.”
Nor does Relator assert any particular line item in the ex-
pense reports is false. Tellingly, while Relator pleads she
“never tracked her own dedication to federal services,” Rela-
tor does not claim her allocation is false. Relator’s presenta-
tion of the differing claimed total reimbursements between
the two expense reports despite “indistinguishable” individ-
ual line items is superficially tempting but does not bear up
under closer scrutiny. Both the IDPH Pandemic Flu and the
IDPH Mass Vaccination expense reports calculate a total
shared expense of $1,862,772.82, a product of each recorded
employee’s salary and the amount of time they dedicated to
federal service. The ultimate claimed reimbursement,

-- 11 of 17 --

12 No. 21-1852
however, is the sum of the government share amount and the
fringe benefits amount. The government share amount is cal-
culated by taking a specified percentage of the total shared
expenses. For the IDPH Mass Vaccination expense report, this
percentage is 50%, yielding a government share amount of
$931,386.41. The fringe benefits amount is calculated by tak-
ing a specified percentage of the government share amount.
For both the IDPH Mass Vaccination expense report and the
IDPH Pandemic Flu expense report, the fringe benefits rate is
30%. For the IDPH Mass Vaccination expense report, the
fringe benefits amount comes to $279,415.92. In total, the ulti-
mate reimbursement claimed under the IDPH Mass Vaccina-
tion expense report—the sum of the $931,386.41 government
share amount and the $279,415.92 fringe benefits amount—is
$1,210,802.33.
The government share amount and the fringe benefits
amount in the IDPH Pandemic Flu expense report differ from
their counterparts in the IDPH Mass Vaccination expense re-
port. The IDPH Pandemic Flu expense report does not indi-
cate the government share rate, and this appears to be the
source of the discrepancy. The total government share
amount reported in the IDPH Pandemic Flu expense report is
$819,620.04, which amounts to 44% of the total calculated
shared expenses of $1,862,772.82. The fringe benefits rate for
the IDPH Pandemic Flu expense report, like that of the IDPH
Mass Vaccination expense report, is 30%. When applied to the
reported government share amount this yields a fringe bene-
fits amount of $245,886.01. All told, Cook County claimed
$1,065,506.05 in reimbursements from the government under
the IDPH Pandemic Flu expense report. Based on the actual
submissions, it appears the differential in claimed reimburse-
ments between the two expense reports is a product of the

-- 12 of 17 --

No. 21-1852 13
structure of the grants themselves, not to the value of federal
services claimed as Relator suggests. And yet, Relator does
not allege the government share rates applied in either the
IDPH Pandemic Flu expense report or the IDPH Mass Vac-
cination expense report are false.
Even if Relator had adequately pleaded the falsity of the
expense reports, she did not sufficiently link them to any gov-
ernment payments. Relator pleads Cook County submitted
the two expense reports to the CDC on September 1, 2011.
Next, Relator alleges the CDC transmitted reimbursement
vouchers to Cook County on September 26, 2011. Relator asks
us to infer the former caused the latter but offers no specific
factual pleadings to support this logical leap. The Second
Amended Complaint is entirely silent as to the purpose of the
expense report, how the CDC uses such reports, or whether
they are a prerequisite to government reimbursement. Rela-
tor’s claim fails.
Further, while Relator alleges Cook County improperly
reallocated restricted H1N1 grant funds to an unrestricted
CCDPH account thereby “undermin[ing] the truth to the
budget and compliance certifications represented by program
managers to qualify and closeout the grants,” she does not al-
lege the certifications were false at the time they were made,
as the FCA requires. See Grenadyor, 772 F.3d at 1105–06. In-
stead, Relator relies upon conduct which, according to the
Second Amended Complaint, took place on November 30,
2011—well after the September 1, 2011, certification—to infer
the certification itself was false at inception. Finally, although
intent may be alleged generally in an FCA claim, Relator ne-
glects to plead any facts from which we may infer Cook
County intended to defraud the government. See United States

-- 13 of 17 --

14 No. 21-1852
ex rel. Presser v. Acacia Mental Health Clinic, LLC, 836 F.3d 770,
781 n.29 (7th Cir. 2016).
The district court properly dismissed Relator’s claims un-
der §§ 3729(a)(1)(A)–(B) of the FCA.
B. Counts III–IV: Improper Retention of Government Funds
In Count III and Count IV, Relator suggests Cook County
improperly retained government funds. Section 3729(a)(1)(D)
prohibits conversion of government funds and assigns civil
liability where someone “has possession, custody, or control
of property or money used, or to be used, by the Government
and knowingly delivers, or causes to be delivered, less than
all of that money or property.” 31 U.S.C. § 3729(a)(1)(D). Sim-
ilarly, a reverse false claim under § 3729(a)(1)(G) proscribes
“knowingly mak[ing], us[ing], or caus[ing] to be made or
used, a false record or statement material to an obligation to
pay or transmit money or property to the Government, or
knowingly conceal[ing] or knowingly and improperly
avoid[ing] or decreas[ing] an obligation to pay or transmit
money or property to the Government.” Id. at § 3729(a)(1)(G).
Claims under both § 3729(a)(1)(D) and § 3729(a)(1)(G) require
Relator to plead Cook County possessed funds that rightfully
belonged to the government.3 See United States ex rel. Yannaco-
poulos v. Gen. Dynamics, 652 F.3d 818, 835 (7th Cir. 2011); see
also United States ex rel. Foreman v. AECOM, 19 F.4th 85, 122
(2d Cir. 2021) (analyzing § 3729(a)(1)(D)). Relator failed to do
so in the Second Amended Complaint.
3 Section 3729(a)(1)(G) also requires Relator to adequately plead a false
statement. See Yannacopoulos, 652 F.3d at 835–36. For all the reasons artic-
ulated in Section II.A, Relator’s reverse false claims cause of action fails on
this basis as well.

-- 14 of 17 --

No. 21-1852 15
At most, Relator pleads Cook County placed federal funds
from the H1N1 grant and the WIC grant in improper ac-
counts. Relator does not plead the funds were due back to the
government. Relator alleges Cook County transferred H1N1
grant funds into a CCHHS discretionary account, in violation
of regulations which mandated segregation of restricted gov-
ernment funds. Nowhere does Relator claim Cook County
was not entitled to the H1N1 funds.
Similarly, Relator objects only to Cook County’s decision
to place the $6.8 million of deferred restricted federal WIC
funds into the CCHHS Enterprise Fund. In the email ex-
change attached to, and cited liberally throughout, the Second
Amended Complaint, Relator emphasizes the $6.8 million in
deferred WIC funds are intended to “provide[] funding for
Salaries and Fringe Benefits of grant employees should cur-
rent grants not be renewed” and “roll[] forward from the pre-
vious grant year and [are] adjusted at grant closing.” This
characterization strongly suggests Cook County was permit-
ted to retain those WIC funds even after the federal grant ex-
pired. Relator’s recommendation to place the $6.8 million in
WIC funds in a segregated “unique Cost Center” reinforces
this conclusion. If Cook County was not entitled to the $6.8
million in deferred federal revenue, it would certainly be odd
to recommend Cook County keep the money. Cook County
ultimately rejected Relator’s suggestion and, instead, placed
the WIC funds into a CCHHS account. Relator claims this was
an error, not because Cook County decided to keep the funds
instead of remitting them back to the government, but be-
cause the WIC funds were deposited into the account of an
agency that did not incur costs related to the grant. At root,
Relator objects to the location of the WIC funds, not Cook
County’s custody of the WIC funds. Moreover, the Second

-- 15 of 17 --

16 No. 21-1852
Amended Complaint is entirely bare of allegations regarding
when, how, and under what circumstances Cook County had
an obligation to return these funds to the government. Once
again, Relator’s allegations amount to nothing more than a
putative regulatory violation.
Finally, Relator fails to plead any facts suggesting Cook
County knew it was in possession of government funds to
which it was not entitled. Grenadyor, 772 F.3d at 1105–06. With
respect to the reclassified H1N1 funds, the Second Amended
Complaint is wholly silent as to Cook County’s knowledge or
lack thereof. As to the WIC funds, while Relator alleges the
assignment to the CCHHS account amounted to a “windfall”
and that she disagreed with this decision, there is no indica-
tion whatsoever Cook County knew it was not entitled to
those funds. See 31 U.S.C. § 3729(a)(1)(G) (requiring
knowledge); see also, e.g., United States ex rel. Harper v. Musk-
ingum Watershed Conservancy Dist., 842 F.3d 430, 438–39 (6th
Cir. 2016) (interpreting § 3729(a)(1)(D) to require knowledge
that the property belongs to the government); Foreman, 19
F.4th at 122 (same). Indeed, Cook County’s Chief Budget Of-
ficer justified placing the funds in the CCHHS account be-
cause, “[p]resumably these are expenses that were absorbed
by the general/health fund when they occurred.” This sug-
gests Cook County was under the impression that the WIC
deferred revenue mirrored already-incurred expenditures.
The district court properly dismissed Relator’s causes of
action for conversion under § 3729(a)(1)(D) and for reverse
false claims under § 3729(a)(1)(G).

-- 16 of 17 --

No. 21-1852 17
C. Dismissal with Prejudice
Relator nominally presents the district court’s decision to
dismiss the Second Amended Complaint with prejudice and
without leave to amend as a basis for appeal. Beyond listing
the issue as a question presented, however, Relator entirely
fails to expound on the position. Indeed, even when Cook
County suggested Relator forfeited this argument such that
plain error applied, Relator did not respond to Cook County’s
position or even contest forfeiture on reply. Relator’s chal-
lenge to the dismissal with prejudice is waived as perfunc-
tory, underdeveloped, and cursory. Shipley v. Chi. Bd. of Elec-
tion Comm’rs, 947 F.3d 1056, 1063 (7th Cir. 2020). Furthermore,
Relator failed to adequately present her claims even after the
district court dismissed her First Amended Complaint with a
detailed discussion of its deficiencies. The dismissal with prej-
udice was proper.
III. Conclusion
For the foregoing reasons, the judgment of the district
court is AFFIRMED.

-- 17 of 17 --