Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, April 18, 2016

Can false claims be implied? High Court to hear arguments

By Sarah E. Baumann, J.D.

The legitimacy of the implied certification theory of liability under the False Claims Act (FCA) (31 U.S.C. §§3729-3733) will the subject of oral arguments before the U.S. Supreme Court on April 19, 2016. The case, Universal Health Services v. U.S. ex rel. Escobar, will ultimately resolve a circuit split between the First and Seventh Circuits regarding the viability of a theory under which claims for reimbursement can be considered legally false under the FCA when parties imply, but do not formally certify, that they have complied with all applicable federal laws. Stay tuned for continued coverage in Health Law Daily.

In Escobar, the First Circuit determined that the United States and the state of Massachusetts stated an actionable FCA claim in alleging that Universal Health Services submitted improper claims for reimbursement to the U.S. government while violating Medicaid regulations that were conditions of payment. In U.S. v. Sanford-Brown, Ltd., however, the Seventh Circuit determined that the government did not have an actionable claim where it alleged that, because an educational institution implied that it was continuing to comply with federal statutes and regulations incorporated by reference into a program participation agreement with the Department of Education, it was liable for the submission of false claims under the FCA (see Does fraud go without saying? Supreme Court to examine ‘implied certification’ in FCA, December 8, 2015).

Companies: Universal Health Services

MainStory: TopStory NewsStory ComplianceNews SupremeCtNews FCANews FraudNews MedicaidPaymentNews QuiTamNews

Back to Top

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.


A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.