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Medicaid › False Claims Act (FCA) › Universal Health Services Inc v United States ex rel Escobar

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Venable LLP

Yes, Contractors and Providers, What You Think Matters - U.S. Supreme Court Unanimously Holds That Defendants' Subjective Beliefs...

Venable LLP on

On June 1, 2023, the U.S. Supreme Court issued a unanimous opinion in United States ex rel. Schutte v. SuperValu Inc. reversing a pair of False Claims Act (FCA) cases on review from the Seventh Circuit Court of Appeals. In...more

Maynard Nexsen

Supreme Court Eliminates Objective Defense for Scienter in False Claims Act Cases

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On June 1, 2023, the Supreme Court eliminated the “objectively reasonable” potential defense in False Claims Act cases, clarifying that the knowledge or scienter element for a False Claims Act (“FCA”) case is satisfied by...more

WilmerHale

Supreme Court Holds That False Claims Act Requires Subjective Inquiry

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On June 1, 2023, the Supreme Court decided a pair of closely watched False Claims Act (FCA) cases, U.S. ex rel. Schutte v. SuperValu Inc., No. 21-1326, and U.S. ex rel. Proctor v. Safeway, Inc., No. 22-111....more

Venable LLP

The Fourth Circuit enforces Safeco's rigorous, objective scienter requirement for Civil False Claims in Sheldon

Venable LLP on

On January 25, in United States ex rel. Sheldon v. Allergan, No. 20-2330 (4th Cir., Jan. 25, 2022), the United States Court of Appeals for the Fourth Circuit upheld a lower-court dismissal of a False Claims Act (FCA) case...more

Dorsey & Whitney LLP

In the First FCA Appellate Case of 2021, the Fourth Circuit Affirms the Dismissal of Relators’ Claims for Lack of Scienter and...

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On January 8, 2021, in the first appellate decision of the year addressing a False Claims Act case, the Fourth Circuit affirmed the summary judgment dismissal of relators’ claims that a manufacturer of allergenic extracts...more

Foley Hoag LLP - White Collar Law &...

White Collar Year in Preview: False Claims Act Trends in 2020

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Editors’ Note: This is the fourth in our start-of-year series examining important trends in white collar law and investigations in the coming year. Our previous entry discussed anti-corruption trends in 2020. Up next: a look...more

Morgan Lewis

Ninth Circuit Panel: Escobar Test for Implied Certification Liability Is Mandatory

Morgan Lewis on

Unless and until the US Court of Appeals for the Ninth Circuit, “en banc, interprets Escobar differently,” a Ninth Circuit panel, relying on past case law, has ruled that relators seeking to establish False Claims Act...more

The Volkov Law Group

Rolling Along with False Claims Act Enforcement Actions (Part III of IV)

The Volkov Law Group on

Despite the controversial impact of the Supreme Court’s Escobar decision, the Justice Department’s False Claims Act prosecutions and settlements are continuing at a consistent rate – heading towards another multi-billion...more

McDermott Will & Emery

Health Care Enforcement Quarterly Roundup - Q2 | July 2018

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Following our inaugural installment of the Health Care Enforcement Quarterly Roundup, we are pleased to be back this quarter with another overview of key enforcement trends in the health care industry. In this issue, we...more

Sheppard Mullin Richter & Hampton LLP

What Have We Learned About False Claims Act Litigation in the Two Years Since Universal Health Services, Inc. v. United States ex...

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Summer is almost here. For some, that means planning vacations to the beach, hitting the gym to shed that winter weight, or perhaps hitting the golf course—but for us at the Sheppard Mullin Healthcare Law Blog and the False...more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

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A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Robinson+Cole Health Law Diagnosis

Escobar Compels Florida District Court to Overturn $350 Million Jury Verdict Arising from Claims of Inadequate Documentation

Robinson+Cole Health Law Diagnosis on

Last month, a U.S. District Court in the Middle District of Florida overturned judgments totaling $347,864,285 returned by a jury under the federal False Claims Act (FCA) and Florida’s state equivalent against the owners and...more

Skadden, Arps, Slate, Meagher & Flom LLP

As Congress Struggles With ACA Repeal, Trump Administration Moves Forward With Regulatory Reform

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The Trump administration and Republican-led Congress spent substantial time and political capital in 2017 on efforts to repeal and replace the Affordable Care Act (ACA) and enact sweeping Medicaid reform. By the end of the...more

Morgan Lewis

Federal Court Strikes Massive False Claims Act Verdict Following Landmark Escobar Ruling

Morgan Lewis on

The ruling in Universal Health Services, Inc. v. Escobar "rejects a system of government traps, zaps, and zingers that permits the government to retain the benefit of a substantially conforming good or service but to recover...more

Dorsey & Whitney LLP

Applying Escobar’s Materiality Standard, Florida Federal Court Reverses $350 Million False Claims Act Verdict against a Nursing...

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If the government does not take action and continues to pay for Medicare/Medicaid claims after it learns of non-compliance related to the claims, is the non-compliance material to the government’s decision to pay? This is a...more

Akerman LLP - Health Law Rx

Florida Federal Court: Escobar Requires Reversal of $348 Million False Claims Act Jury Verdict

Akerman LLP - Health Law Rx on

The United States District Court for the Middle District of Florida vacated a large jury verdict in a False Claims Act case against the owners and operators of nursing homes because the evidence did not satisfy the...more

Alston & Bird

Implied False Certification Liability Under the False Claims Act: How the Materiality Standard Offers Protection after Escobar

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The False Claims Act (FCA), initially enacted in 1863 during the Civil War, was sponsored by the Lincoln administration to curtail the rampant fraud and excessive profiteering being perpetuated by government contractors, who,...more

King & Spalding

Florida Court Tosses $350 Million False Claims Act Verdict Under Escobar’s Materiality Standard

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On January 11, 2018, a Florida Federal court vacated a $350 million jury verdict against Salus Rehabilitation—an operator of specialized nursing facilities—in a non-intervened case under the Federal False Claims Act (FCA) and...more

Troutman Pepper

Lessons From a Year of Escobar

Troutman Pepper on

It has been one year since the U.S. Supreme Court’s landmark ruling in Universal Health Services v. United States ex rel. Escobar, which resolved a circuit split as to the validity of the implied false certification theory...more

Mintz - Health Care Viewpoints

Implied False Certification Theory Fails in FCA Case Against Billing Agent

Mintz - Health Care Viewpoints on

A court in the Southern District of New York (“SDNY” or the “Court”) recently released an important decision applying the Supreme Court’s landmark Escobar ruling to a qui tam action involving percentage fee arrangements for...more

King & Spalding

SDNY District Court Judge Rules Escobar FCA Test Is Mandatory

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District courts nationwide have been split on the issue of whether the two-part falsity test set forth in the U.S. Supreme Court’s opinion in Universal Health Services v. Escobar must always be satisfied in federal False...more

Manatt, Phelps & Phillips, LLP

Escobar's Impact: Recent Application of "Materiality" in Ninth Circuit

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Last year, a unanimous U.S. Supreme Court decided Universal Health Services, Inc. v. United States ex rel. Escobar (Escobar), 136 S.Ct. 1989 (2016), creating important implications for Federal False Claims Act (FCA) cases...more

Farrell Fritz, P.C.

“Implied Certification” Theory Allowed Under the False Claims Act

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The Supreme Court recently allowed liability through the implied certification theory of the False Claims Act (FCA), which was raised and upheld in Universal Health Services, Inc. v. United States ex rel. Escobar. The...more

WilmerHale

Materiality Under FCA: The Lower Courts Grapple With Escobar’s Meaning

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The Supreme Court’s decision in Universal Health Services v. Escobar ex rel. United States sought to clarify the standard for materiality under the False Claims Act, but lower courts have already begun to adopt different...more

McCarter & English, LLP

Universities Are Prime Targets for False Claims Act Liability

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Colleges and universities receive billions of dollars in federal funds, whether through research grants or student financial aid, or even by billing Medicare or Medicaid for services rendered at academic medical centers. As a...more

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