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Morning Briefing

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Friday, Jun 17 2016

Full Issue

High Court Avoids Straightforward False Claims Ruling But Sets Limits For Future Cases

In its 8-0 decision on Universal Health Services v. Escobar, the court tried to strike a balance between combating health care fraud and protecting companies from what could be viewed as limitless False Claims Act cases, experts say.

The U.S. Supreme Court on Thursday imposed some limits on the kind of fraud claims that can be brought against federal contractors in a case involving a suit against one of America's largest hospital operators over a woman's death at one of its facilities. But the 8-0 ruling was not the broad victory for business sought by the company, Universal Health Services, and other healthcare providers fearful of suits under the U.S. False Claims Act, which lets individuals make claims that the federal government has been defrauded. (Hurley, 6/16)

The eight-member Supreme Court showed again Thursday it can issue rulings in significant cases without actually deciding who wins. The justices issued a unanimous 18-page opinion in a major case of healthcare fraud that had appeared to leave them sharply divided during oral arguments in April. They achieved agreement by adopting some key arguments of each side. Then they sent the entire dispute back to a federal appeals court to take a second look. This method of ruling without deciding has emerged in response to the death of Justice Antonin Scalia and the lack of a tie-breaking vote in closely contested cases. (Savage, 6/16)

The court ruled that companies are subject to False Claims Act liability and the implied certification theory, but only if two conditions are met. First, claims from healthcare providers must request payment and make 鈥渟pecific representations about the goods or services provided,鈥 which often is the case if providers use standard Medicare and Medicaid billing forms. Second, an organization's failure to disclose noncompliance with 鈥渕aterial鈥 requirements would equate to 鈥渕isleading half-truths.鈥 (Aguilar and Herman, 6/16)

The US Supreme Court Thursday handed a partial victory to a Massachusetts family who sued the country鈥檚 largest owner of psychiatric hospitals over the death of their daughter. But the justices sent the case back to a lower court for further review. (Kowalcyzk, 6/16)

Meanwhile, in a separate case involving veterans聽鈥

The Supreme Court decided Thursday that the Department of Veterans Affairs must set aside more contracts to be filled by veteran-owned small businesses. The court was unanimous that the department has not fulfilled its obligation to steer more business to small companies owned by veterans or service-disabled veterans simply by meeting its annual goal. The decision is likely to help more veteran-owned businesses compete for the billions of dollars in contracts the department awards. (Barnes, 6/16)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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