Georgia's Trusted Healthcare
& Medical Provider Attorneys

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 or Jonathan Anderson at

Healthcare Providers: Are You Compliant With The New Overtime Rule?

Over time healthcare providerThe U.S. Department of Labor recently announced a Final Rule that substantially increases the number of salaried workers who will receive overtime.

The new rule, which goes into effect on December 1, 2016, is expected to affect 4.2 million workers – including healthcare employees.

Currently, employers did not have to pay overtime to salaried workers earning more than $23,600. The new Final Rule increases that threshold to $47,476 with automatic future increases.

The Final Rule will particularly affect healthcare businesses and professionals. The average salaries for nurses, medical and physical therapists, medical and pharmacy technicians, and paramedics is between $25,710 and $47,010. [1]

However, there is some exceptions for certain Medicaid providers. Providers that serve individuals with intellectual and developmental disabilities do not have to increase salaries until March 17, 2019. The delay is for providers of Medicaid-funded services “for individuals with intellectual or developmental disabilities in residential homes and facilities with 15 or fewer beds.”[2]

The delay addresses concerns that the change would increase the cost of paying workers, without the ability to increase the revenue from Medicaid payments.

While the non-enforcement policy is a boon to home and community based providers, it will not affect private pay ID/DD providers. The Administration’s Final Rule is likely to raise costs for those private pay providers because the cost of labor will increase as many more salaried workers are entitled to overtime pay.

Healthcare providers should review their compensation structures to ensure they comply with the new overtime rules. Providers who believe they meet the exception for Medicaid funded ID/DD services should ensure they meet the exception.

Jeyaram & Associates is a full service healthcare law firm and can review employers’ salary structures to ensure compliance with the new law. For assistance, contact DJ at or 678.325.3872.