United States Court of Appeals For the Seventh Circuit ____________________ No. 24-1858 ANDREA RATFIELD, et al.,

Plaintiffs-Appellants,

v. UNITED STATES DRUG TESTING LABORATORIES, INC., et al., Defendants-Appellees. ____________________

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No. 1:23-cv-15063 — Robert W. Gettleman, Judge. ____________________

ARGUED JANUARY 16, 2025 — DECIDED JUNE 13, 2025 ____________________

Before SCUDDER, KIRSCH, and LEE, Circuit Judges. LEE, Circuit Judge. Plaintiffs, comprised of Andrea Ratfield, ten other pilots, a physician, a nurse, and an attorney, were all required to undergo alcohol testing to maintain their employ- ment and professional licenses. Here, the testing came in the form of a dried blood spot test developed by United States Drug Testing Laboratories, Inc. (USDTL). According to USDTL, its test (which we will refer to as DBS) is designed to 2 No. 24-1858 detect phosphatidylethanol (PEth), a biomarker of alcohol consumption. The DBS tests for Ratfield and the others indi- cated positive for PEth, presumably meaning that they had continued to consume alcohol even while participating in their treatment programs. These positive tests, Plaintiffs al- lege, resulted in significant professional harm. Asserting that the DBS tests were not as reliable as USDTL touted, the fourteen individuals sued USDTL and two of its officers (collectively, the USDTL Defendants) under the Rack- eteer Influenced and Corrupt Organizations Act, 18 U.S.C. § 1962 (RICO), and state law. They also named as defendants Choice Labs Services (CLS), the company that provided the DBS tests to the test administrators, and its owners (collec- tively, the CLS Defendants). The district court dismissed the RICO claims under Federal Rule of Civil Procedure 12(b)(6) and denied supplemental jurisdiction as to the state law claims. We affirm. I The crux of Plaintiffs’ RICO claims is their allegation that USDTL marketed its DBS test as a reliable indicator of contin- uing alcohol use when, in fact, the company had failed to con- firm the test’s validity and reliability. Some background into the various players will be helpful. 1 USDTL is a business-to-business specimen testing labora- tory that developed the DBS test. Douglas Lewis is USDTL’s

1 The background facts are taken from the second amended com- plaint. On appeal, we treat the allegations as true and view them in the light most favorable to Plaintiffs. See Moranski v. Gen. Motors Corp., 433 F.3d 537, 539 (7th Cir. 2005). No. 24-1858 3 founder, president, and scientific director, and Joseph Jones is USDTL’s chief operating officer and executive vice president. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that regulates all non-research laboratory testing on humans in accordance with the Clinical Laboratory Improvement Amendments, 42 U.S.C. § 263a, and its imple- menting regulations, 42 C.F.R. Part 493 (together, CLIA). The purpose of the CLIA is to ensure the accuracy and reliability of laboratory tests, and CLIA certification signifies that a la- boratory has met statutory and regulatory conditions. USDTL claims to be CLIA-certified and -compliant. Ratfield and the other pilots participated in the Human In- tervention Motivational Study (HIMS) program, a substance abuse treatment program that helps professional pilots return to cockpits after recovering from alcohol or other substance use disorders. HIMS requires pilots to submit to frequent drug or alcohol testing to rule out con