Articles Tagged with implied certification under the False Claims Act

Last year, our health care fraud whistleblowers’ law firm reported on an important issue in the False Claims Act arena: implied certification.  The implied certification theory has the potential to be a powerful tool in the fight against fraud and, when we last discussed the topic, the Fourth Circuit Court of Appeals had ruled in favor of the theory.  However, there has been disagreement on the issue among the federal appellate courts and the issue is headed to the Supreme Court.  We continue to believe in the implied certification theory and we are closely following the issue as it makes its way to the highest court in the land.

The Escobar Case

As Modern Healthcare recently reported, the implied certification theory is heading to the Supreme Court via the case of Universal Health Services v. United States ex rel Escobar.  The case involves a claim filed by the parents of a teenager who died while under the care of a mental health clinic.  The plaintiffs allege that the clinic’s staff was not properly supervised and that the clinic lacked required board-certified or board-eligible supervisory personnel.  As the First Circuit wrote, “The crux of their complaint is that [Defendants’] alleged noncompliance with sundry supervision and licensure requirements rendered its reimbursement claims submitted to the state Medicaid agency actionably false under both the federal and Massachusetts False Claims Acts.”