The causation element under the False Claims Act is a matter of significant controversy being adjudicated in federal courts. The matter arises when claims are submitted for government reimbursement for items or services rendered or provided under federal health-care programs, in which a violation of the Anti-Kickback Statute is alleged.
On interlocutory appeal, the US Court of Appeals for the First Circuit inUnited States v. Regeneron on Feb. 18 decided the burden of proof the government must meet for the causation element under the FCA. A three-judge panel ruled the government must meet a “but-for” proof standard, adding to a circuit split.
The FCA specifies elements that must be proven for there to be a violation of the AKS. In 2010, Congress amended the statute to explicitly provide that, for the causation element under the FCA, a Medicare claim for payment for items and services “resulting from a violation” of the AKS constitutes a false claim under the FCA, creating a per se rule of falsity.
There is a circuit split about the meaning of “resulting from” in the text of the 2010 amendment. As pertinent here, the government filed a lawsuit involving the amendment against Regeneron Pharmaceuticals Inc. in the US District Court for the District of Massachusetts.
In United States v. Regeneron, the government...
A father has been jailed and his wife is awaiting sentencing in a multigenerational insurance claim fraud. Patrick Lawrence (54), his wife Eileen (52), and sons Tom (24) and John (26), who were ch...