SCOTUS Ruling on False Claims Act Has Big Implications

Managed Healthcare Executive

George B. Breen, a Member of the Firm in the Health Care and Life Sciences and Litigation practices and Chair of the firm’s National Health Care and Life Sciences Practice Steering Committee, authored an article in Managed Healthcare Executive titled “SCOTUS Ruling on False Claims Act Has Big Implications.” Mr. Breen’s article discusses how the Supreme Court’s upcoming decision on Universal Health Services, Inc. v. United States ex rel. Escobar may affect the health care industry.

Following is an excerpt:

At issue in Escobar is whether the theory is viable and if its viability depends on whether the provisions at issue were expressly designated as preconditions of payment. The First Circuit ruling being challenged held that preconditions of payment need not be “expressly designated,” calling for a “fact intensive” and “context specific” analysis of the applicable provisions of the contract, statute or regulation at issue.

During oral argument, some Justices expressed concern with this theory. Chief Justice Roberts specifically noted the difficulty in complying with “hundreds, thousands of pages of regulations,” suggesting that he was troubled that an expansive view of this theory could turn any material contractual breach into a cause of action under the FCA.