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What do I need to know about the Supreme Court’s recent FCA ruling?

The False Claims Act (FCA) is a powerful legal tool used by the government to go after those it believes are attempting to defraud government programs for their own financial gain. Powerful and well used, as this law is responsible for over $78 billion in recouped payouts since 1986.

Although around for decades, the courts continue to provide guidance on its reach and application. It is important for those who file claims with government programs like Medicare to stay current on these rulings, as they can affect their practices.

What did SCOTUS tell us about claimant filing, timing, and belief when it comes to FCA cases?

The Supreme Court of the United States (SCOTUS) agreed to hear a case that dives into whether a defendant’s belief about a claim will impact an FCA case. It turns out timing matters. SCOTUS held that one of the key elements to these cases is what the claimant believed at the time they filed the claim.

How does this work?

Take, for example, a situation where a doctor files a claim for payment and thinks it may not qualify. He receives payment and later faces allegations of a FCA violation. According to this ruling, the government could build a case based on the argument that the medical professional believed the claim was false at the time of filing. But what if the physician realized a reasonable explanation after filing? Justice Clarence Thomas writes that a reasonable explanation after filing the claim does not change the facts. The law, he goes on to explain, focuses on the belief at the time of submission of the claim.

What should medical practitioners and other healthcare professionals learn from this case?

This is one of many nuances to explore when building a defense to allegations of an FCA violation. It is important to carefully review these and others when facing similar allegations.

Attorney John Rivas is responsible for this communication