SCOTUS To Rule on ‘Implied Certification’ in Health Care Fraud Cases
On Friday, the Supreme Court announced it will hear a case that focuses on whether the federal government can use certain whistleblowers to bring challenges against health care providers for alleged violations of the False Claims Act, Modern Healthcare reports.
Universal Health Services v. United States ex rel. Escobar centers on whether whistleblowers and federal regulators have the authority to bring health care providers to court over false claims charges in cases of "implied certification." Such cases come about when whistleblowers allege that providers submitted false claims because they did not adhere to specific government regulations, even if the government has not explicitly said such rules are a condition of payment and the provider has never reported it had met them.
Lower courts have issued conflicting rulings on the matter. Some courts have ruled that it is unreasonable to sue providers for failing to comply with countless federal and state regulations regarding claims filing. The rulings noted that such violations should be handled by state and federal agencies instead of the courts.
Further, Universal Health Services in court papers argued that the False Claims Act could become "a punitive sanction for use against minor regulatory or contractual violations" if regulators are allowed to sue providers based on implied certification violations.
Meanwhile, other courts have ruled that such cases are permissible.
Larry Freedman, an attorney at Mintz Levin who defends providers in False Claims Acts cases, called the Supreme Court's decision to take the case "a huge deal for health care providers." He added that "the major driver" of lawsuits involving health care whistleblowers involve implied certification.
According to Freedman, the high court could rule to completely invalidate implied certification cases or to limit their use to cases in which a provider violates regulations that the federal government has clearly stated are conditions of payment, which could decrease the number of such cases that are filed.
David Chizewer, an attorney at Goldberg Kohn who represents whistleblowers, said he thinks the Supreme Court will completely eliminate implied certification cases. He noted that doing so could help providers to be more aware of which actions definitely violate the False Claims Act (Schencker, Modern Healthcare, 12/8).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.