The AAMC, along with the American Hospital Association and the Federation of American Hospitals, Jan. 27 submitted an amicus brief to the U.S. Supreme Court in the case of Universal Health Services, Inc. v. United States and Commonwealth of Massachusetts ex rel. Julio Escobar and Carmen Correa.
The issue presented to the Supreme Court is whether False Claims Act (FCA) liability extends to claims for reimbursement that fail to comply with requirements that are not explicitly linked to payment of the claim, such as licensure and supervision. If the Supreme Court sides with the whistleblowers in this case, hospitals, physicians, and others could be subject to false claims for alleged noncompliance with contractual and other requirements, which would hugely expand the reach of the FCA.
The brief argues, “FCA liability should only attach when a defendant submits a claim that it knows is ineligible for payment because some expressly designated condition for payment of that claim has not been satisfied.” To hold otherwise “defies logic” as it would “treat a health care provider’s submission of a claim as an implicit certification that the provider is in perfect compliance with every single requirement applicable to the healthcare programs.” Argument has not yet been scheduled but would be no earlier than the end of March.