Supreme Court Ruling on the False Claims Act: Providing Whistleblowers a Wider Net?

When it comes to quality-based reimbursements, healthcare organizations face greater compliance risk, and the recent Supreme Court decision to uphold the “implied false certification” theory of liability under the False Claims Act (FCA) underlines just that.

The June 16 decision, which affirms a Medicaid payment request as an “implied certification of compliance” with pertinent statutes, regulations or contract requirements, has outsized implications for the healthcare industry in several ways including:
  • Greater validation of value-based outcomes is required. Income for providers depends on this, and they’ll have to validate care results with increased due diligence.
  • The industry will see an increase in fraud allegations. The Court’s ruling casts a longer shadow on what constitutes a false claim, so fraud investigations will likely increase.
To view additional compliance implications of the Court’s decision, you can view BDO’s full alert here. Healthcare organizations with questions about FCA implications specific to their organization or facility are invited to reach out to BDO:
 
Patrick Pilch
BDO Healthcare Advisory Practice Leader and Managing Director
                     Stephanie Giammarco
BDO Consulting Partner, National Leader, Forensic Technology Services

 
Glenn Pomerantz
BDO Consulting Partner Global Forensics Practice Leader
  Daniel Ventricelli
BDO Consulting Managing Director