Posts by Patrick E. Fitzsimmons

Supreme Court Declines to Review “Objective Falsity” Issue and Resolve Circuit Split

Patrick E. Fitzsimmons — Mon, 08 Mar 2021 09:00:01 -0500

Several months ago, we posted a blog discussing how Circuit Courts are split on the question of whether the False Claims Act requires objective falsity, or whether a difference of opinion regarding medical necessity is sufficient to support an actionable claim. Despite this Circuit split, the Supreme Court recently denied certiorari in two cases—one from the Third Circuit and one from the Ninth Circuit—that would have allowed the Court to address the issue of “objective falsity.”

Ninth Circuit Finds False Certifications of Medical Necessity Actionable Under the FCA

Patrick E. Fitzsimmons — Tue, 13 Oct 2020 09:00:02 -0400

When a person insured by Medicare or Medicaid receives medical services, the service-provider is often required to certify that the services are medically necessary. The Ninth Circuit Court of Appeals recently joined the Third, Fifth, and Tenth Circuits in finding false certifications of medical necessity actionable under the False Claims Act.

Tenth Circuit Affirms Summary Judgment Reinforcing Escobar’s Materiality Requirements

Patrick E. Fitzsimmons — Wed, 19 Feb 2020 09:00:03 -0500

On February 7, 2020, the Tenth Circuit affirmed a district court’s decision to grant summary judgment in favor of the defendant hospital. See United States ex rel Janssen v. Lawrence Memorial Hospital, __ F.3d __ (10th Cir. 2020). In doing so, the Tenth Circuit reinforced the rigorous materiality standard set forth in the Supreme Court’s 2016 Escobar decision.

SCOTUS Finds that Violating FCA’s Seal Requirement Does Not Mandate Dismissal

Patrick E. Fitzsimmons — Fri, 09 Dec 2016 09:00:04 -0500

The Supreme Court, in a unanimous decision, ruled in State Farm Fire & Cas. Co. v. United States ex rel. Rigsby et al., 580 U.S. ___ (2016) that a seal violation does not mandate dismissal of a relator’s complaint.

Supreme Court Finds the “Implied Certification” Theory Viable in Some Circumstances

Patrick E. Fitzsimmons — Wed, 17 Aug 2016 09:00:05 -0400

On June 16, 2016 the United States Supreme Court issued a unanimous decision in Universal Health Services, Inc. v. United States ex rel. Escobar, 579 U.S. ___, No. 15-7 (June 16, 2016), finding the “implied certification” theory of legal falsity under the False Claims Act (“FCA”) viable in some circumstances. This controversial theory, under which courts have allowed liability in circumstances where defendants have failed to disclose noncompliance with relevant statutory, regulatory, or contractual requirements, is now still viable, albeit in more limited form.

United States Supreme Court to Determine the Viability of the “Implied Certification” Theory of Legal Falsity under the False Claims Act

Patrick E. Fitzsimmons — Wed, 04 May 2016 09:00:06 -0400

In the coming months, the Supreme Court will render a landmark decision and determine the viability of the “implied certification” theory of legal falsity under the False Claims Act. The Supreme Court recently heard oral argument in this landmark case where the relators claim the defendant, Universal Health Services, presented false claims for payment under the “implied certification” theory. The case is before the Supreme Court on appeal from the First Circuit’s decision in United States ex rel. Escobar v. Universal Health Services, 780 F.3d 504 (1st Cir. 2015).