SCOTUS to hear big­gest False Claims Act case in more than 30 years

Modern Healthcare - - THE WEEK AHEAD - —Lisa Schencker

The Supreme Court this week will hear ar­gu­ments in a case that will af­fect the num­ber of fraud cases against providers.

The case, Uni­ver­sal Health Ser­vices v. United States ex. rel. Es­co­bar, fo­cuses on the va­lid­ity of a le­gal the­ory now used to bring many False Claims Act cases against providers and oth­ers.

Un­der the the­ory of im­plied cer­ti­fi­ca­tion, whistle­blow­ers of­ten al­lege providers sub­mit false claims to govern­ment pro­grams by fail­ing to fol­low cer­tain reg­u­la­tions. Providers are some­times held li­able even if the govern­ment never ex­plic­itly stated that fol­low­ing a reg­u­la­tion was a con­di­tion of pay­ment and even if the provider never ex­plic­itly vouched that it had com­plied with the reg­u­la­tion.

It’s the big­gest False Claims Act case to be weighed by the Supreme Court in more than 30 years, said Peter B. Hutt II, a part­ner at Cov­ing­ton & Burl­ing who rep­re­sents providers in False Claims cases. Hutt said the case would be the “polestar” for any fu­ture de­ci­sions from cir­cuit or district courts wrestling with how far the statute goes.

The Amer­i­can Hospi­tal As­so­ci­a­tion, the Amer­i­can Med­i­cal As­so­ci­a­tion and the Phar­ma­ceu­ti­cal Re­search and Man­u­fac­tur­ers of Amer­ica are all urg­ing the court not to al­low im­plied cer­ti­fi­ca­tion be­cause, they say, it’s not the same as fraud. But AARP and men­tal health and whis­tle-blower groups say the the­ory can pro­tect pa­tients from sub­stan­dard care.

The pe­ti­tion­ers in the case, for ex­am­ple, brought it af­ter their daugh­ter died at a Mas­sachusetts men­tal health clinic. They al­leged her care­givers were not prop­erly su­per­vised, and there were no board-cer­ti­fied or -el­i­gi­ble psy­chi­a­trists and no li­censed psy­chol­o­gists at the fa­cil­ity, which vi­o­lates state Med­i­caid reg­u­la­tions.

A de­ci­sion in the case is ex­pected by June. In re­cent years, the Supreme Court has of­ten de­cided False Claims Act cases unan­i­mously, or nearly unan­i­mously, Hutt said.

Hutt says the case’s out­come will have far­reach­ing con­se­quences.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.