The emerging battle over ‘objective reasonableness’ in False Claims Act cases

June 1, 2022

By: Michael A. Morse , Alexander M. Owens

The Medicare and Medicaid programs are exceedingly complex, and navigating the myriad statutes, regulations, rules, and guidance presents significant challenges for all healthcare providers and compliance professionals—even the United States Supreme Court has recognized that the Medicare program is a “complex and highly technical regulatory program.”[1] This job is sometimes made even more difficult because program regulations can be ambiguous, and government officials are often unable or unwilling to provide further clarification. Add to the mix that failure to comply with Medicare and Medicaid regulations can result in False Claims Act (FCA) liability, and many healthcare providers can’t help but express frustration. A new battle emerging in the courts may afford healthcare providers some relief when confronted with ambiguous Medicare and Medicaid regulations.

In United States ex rel. Schutte v. SuperValu Inc., decided on August 12, 2021, the Seventh Circuit Court of Appeals held that a defendant does not knowingly submit a false claim “if (a) it has an objectively reasonable reading of the statute or regulation and (b) there was no authoritative guidance warning against its erroneous view.”[2] In it, the Seventh Circuit joined the Third, Eighth, Ninth, and D.C. Circuits in endorsing an objective reasonableness standard under the FCA. However, the Seventh Circuit, over a vigorous dissent, went further than the other courts, which have recognized an objective reasonableness standard, setting up a battle that could significantly affect future FCA cases.

Read more here,

Copyright 2022 Compliance Today, a publication of the Health Care Compliance Association (HCCA).

News & Events

Related News

24 Pietragallo Lawyers Named in 2022 Pennsylvania and Florida Super Lawyers and Rising Stars
May 23, 2022
Pietragallo is pleased to announce that 24 lawyers have been named as 2022 Super Lawyers and Rising Stars, including partner Marc Raspanti who was recognized in the Top 100 in Pennsylvania and Philadelphia. Read More
Alliance Family of Companies and Ancor Capital Partners Pay $15.3M to Settle False Claims Suits
July 22, 2021
The Department of Justice and the United States Attorney’s Office for the Southern District of Texas, has announced the settlement of six qui tam cases filed in Houston, Dallas, and Philadelphia.  Read More
View More News & Events