When Is a Potential Overpayment Identified?

Current Pedorthics November/December 2015

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 Current Pedorthics titled “When Is a Potential Overpayment Identified?” The article discusses the first court opinion on when an overpayment is considered “identified” by a health care provider under the False Claims Act.

Mr. Breen provides his analysis of United States ex rel. Kane v. Healthfirst, Inc., et al., No. 1:11-cv-02325 (S.D.N.Y. Aug. 3, 2015) in the following excerpt:

The Kane decision presents a novel and solitary statutory interpretation that other courts are likely to grapple with. Focusing on what it believed were the operative facts, the Kane court found that the overpayments alleged had been “identified” at the point that the relator presented his evidence to management. Irrespective of the particulars of the case itself, this troubling conclusion is something that providers need to anticipate when allegations of potential overpayments are made.