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Healthcare Providers Need To Ensure Compliance Under Expansion of False Claims Act

False Claims Act Attorney The U.S. Supreme Court voted unanimously to allow False Claims Act (FCA) liability under the “implied certification theory.”

The implied certification theory means that submitting a claim to the government implies that the entity has complied with all contractual and regulatory requirements.

What The Supreme Court Ruling Means To Healthcare Providers

This decision could have profound repercussions for healthcare providers who bill federal healthcare programs. Healthcare providers must contend with the Stark Law and Anti-Kickback Statute (“AKS”). Violations of either the Stark law or AKS give rise to FCA liability. Healthcare cases make up approximately two-thirds of federal whistle-blower cases, which are enforced using the FCA.

The Supreme Court did not limit liability under the implied certification theory to conditions of payment. This ruling can potentially mean that a facially valid invoice can violate the false claims act case because of requirements that are not explicitly requirements for payment. If a regulation is a condition of participation but not a condition of payment, a violation can still give rise to FCA liability.

The Supreme Court did rule that liability is limited to “material” violations. Materiality may be shown if it is a provision for which the government routinely denies payment. The Court emphasized that the materiality test is “rigorous” and demanding….”

Healthcare Providers Need To Ensure Compliance 

Healthcare providers, and all contractors billing the government, should ensure they are compliant with all statutory, regulatory and contractual requirements.

Jeyaram & Associates’ attorneys have extensive experience in helping healthcare providers remain compliant with all state and federal regulations. Contact DJ Jeyaram at DJ@JeyLaw.com or Jonathan Anderson at Janderson@JeyLaw.com.

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