On March 28, 2023, the United States Court of Appeals for the Sixth Circuit issued its opinion in United States ex rel. Martin v. Hathaway, holding that plaintiffs in False Claims Act (FCA) cases alleging a violation of the Anti-Kickback Statute (AKS) must establish that the false claim would not have occurred "but for" the illegal kickbacks. Circuit decisions have been split regarding what kind of causal connection plaintiffs must establish between the kickbacks and claims submitted to the government. Some decisions side with plaintiffs and favor a more relaxed causation requirement, while others require but-for causation, which favors defendants. This latest Sixth Circuit opinion deepens the circuit split for healthcare defendants.
The FCA imposes civil liability for knowingly presenting, or causing to be presented, a false or fraudulent claim to the government for payment or approval. The AKS prohibits medical providers from making referrals for remuneration. Remuneration is not statutorily defined, but courts have generally found it can include cash in direct payments or excessive compensation for other services or anything else of value, such as free rent, expensive trips and meals and other gifts provided in exchange for patient referrals. The Patient Protection and Affordable Care Act amended the AKS to state that a billing or claim "resulting from" a violation of the Statute constitutes a false or fraudulent claim under the FCA. However, this amendment did not...
ALOR GAJAH: An army major claimed trial at the Ayer Kerod Sessions Court here today to five charges of submitting false claims involving maintenance work and non-existent raw material supplies wor...