Supreme Court to hear FCA case on 'implied certification'

High court will determine whether a claim can be legally false if payment conditions are not expressly stated
Tools

The U.S. Supreme Court has agreed to hear a case that will determine whether Medicaid claims can be considered false if a provider does not adhere to "implied" program requirements, according to Courthouse News Services.

The Court aims to answer a longstanding question regarding "implied certification," which has prompted a number of whistleblower suits in recent years. The case involves claims submitted by Universal Health Services for mental health services provided at a Lawrence, Massachusetts clinic. Federal and state prosecutors argued that claims submitted by the provider were false because the company employed unlicensed counselors. Although a district court dismissed the lawsuit, an appellate court ruled that the regulations were a condition of payment, even though they weren't explicitly stated in Medicaid payment conditions.                                                  

The case could be particularly interesting for long term care providers and rehab specialists that often see FCA lawsuits involving implied certification, according to McKnight's.

Whistleblowers continue to make up a large portion of False Claims Act (FCA) claims, some of which have been filed under the implied certification standard. Last year, the Supreme Court agreed to hear an FCA case that many feared would impact whether or not whistleblowers could file multiple lawsuits. The Court ultimately overturned the provision of the FCA, ruling that the "first-first-to file" interpretation does not apply to FCA cases, which led some legal experts to wonder if providers would see an increase in FCA whistleblower lawsuits.  

For more:
- read the Courthouse News Services article
- here's the McKnight's article

Related Articles:
Supreme Court hears False Claims Act case that could have healthcare implications
Supreme Court reverses False Claims Act's lack of limitations on civil suits
Federal False Claims Act scrutiny shows no signs of letting up
Supreme Court decision expands False Claims Act liability for providers