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

23 Pietragallo Lawyers Named in 2023 The Best Lawyers in America and Ones to Watch
August 18, 2022
Pietragallo Gordon Alfano Bosick & Raspanti, LLP is pleased to announce that 23 lawyers have been named as 2023 The Best Lawyers in America and 2023 Ones to Watch, including Tama Beth Kudman who was recognized as 2023 Lawyer of the Year in West Palm Beach for Criminal Defense: White-Collar. Read More
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

Upcoming Events

Eric Soller to moderate 33rd Annual Academy of Trial Lawyers Federal Court Program
December 16, 2022
On Friday, December 16, 2022, Pietragallo partner Eric Soller will moderate the 33rd Annual Academy of Trial Lawyers Federal Court Program. Read More
Tama Beth Kudman to present at National Association of Criminal Defense Lawyers’ Advanced Criminal Law Seminar
January 23, 2023
Pietragallo partner Tama Beth Kudman will be presenting at the National Association of Criminal Defense Lawyers’ (NACDL) Advanced Criminal Law Seminar. Read More
View More News & Events