This Tuesday, April 18, 2023, the U.S. Supreme Court heard argument in U.S. v. SuperValu. SuperValu is the second – and more consequential – False Claims Act (FCA) case of the term. It's unusual for the Court to take two FCA cases in a single term, though not entirely unexpected in an environment in which billions of dollars a year have been recovered by whistleblowers – primarily in the healthcare sector – and the Department of Justice is aggressively prosecuting health care fraud, at times in parallel investigations. The case will decide whether companies can be liable under the FCA for claims submitted to the government, and thus exposed to immense treble damages and attorneys' fees, in addition to penalties as high as $25,000 per claim, even if they embrace an "objectively reasonable" view of the law that turns out to be incorrect. (BCLP's analysis of the issues and ramifications for the upcoming ruling are featured recently on Law360; subscription may be required.)
Health care companies continue to navigate complex regulations, especially in times where interpretation is required, without clear guidance. The Court's ruling will have an immediate impact across the sector. For example, health care companies commonly deal with this when submitting claims to Medicare and Medicaid and face potential fraud allegations related to the claims concerning medical necessity, compliance with various CMS requirements, or bundling and unbundling of services.
In SuperValu, emails...
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