SCOTUS to decide the issue of “implied certification” in Universal Health Services v. United States ex rel. Escobar
On December 4, 2015, the Supreme Court granted the defendant United Health Services’ Petition for a Writ of Certiorari to decide, among other things, the issue of whether the “implied certification” theory of legal falsity under the False Claims Act is viable.
Escobar involved a teenaged girl, a Medicaid beneficiary, who was treated by unlicensed workers who had held themselves out to be social workers, psychologists, and psychiatrists, when they were nothing of the sort. Treatment by these workers led to the girl’s death when she was prescribed a drug that caused her to have seizures, one of which was fatal.
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This June, federal officials announced the largest coordinated criminal Medicare fraud action and the first large-scale effort focused on Medicare Part D fraud in the history of the U.S. Justice Department. The Medicare Fraud Strike Force levelled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes. Those charged with fraud under the False Claims Act included 46 doctors, nurses and other licensed medical professionals.
This June, Senate Judiciary Committee Chairman Chuck Grassley and Ranking Member Patrick Leahy introduced legislation to extend whistleblower protection for employees who provide information to the Department of Justice related to criminal antitrust violations.
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