Tag archives: US Supreme Court

U.S. Supreme Court Rules that the Federal Government “Shall” Pay Health Insurers $12 Billion Under the Risk Corridors Program

On Monday, April 27, 2020, the U.S. Supreme Court ruled, in an 8-1 decision, that the federal government is required to pay health insurers $12 billion under the Patient Protection and Affordable Care Act’s (ACA) risk corridors program. Background of the Case Congress in the ACA created three premium stabilization programs to support insurers during … Continue reading

Allina Update: Supreme Court holds Medicare statute requires notice and comment for DSH payment change

By Yvonne Puig (US), Thomas Dowdell (US), Frances Morgan (US) and Jeff Wurzburg (US) on June 4, 2019 Posted in News from DC

In a decision with potentially far reaching implications for Medicare hospital reimbursement, on June 3 the U.S. Supreme Court ruled 7-1 against the U.S. Department of Health and Human Services (“HHS”) in Azar v. Allina Health Services. The Court affirmed the U.S. Court of Appeals for the D.C. Circuit decision that vacated a rate calculation … Continue reading

Court applies Escobar, overturns $350M False Claims Act verdict

By on January 16, 2018 Posted in Enforcement

In Universal Health Services v. U.S. ex rel Escobar, the United States Supreme Court emphasized the importance of the materiality standard in False Claims Act cases. Since that decision, litigants have anxiously awaited further guidance on how Escobar’s instructions would be applied by lower courts. In U.S. ex rel Ruckh v. Salus Rehabilitation, LLC et … Continue reading

Judge doubles down on finding of materiality in FCA case

By Joseph Keillor (US) and Sarah Jean Kilker (US) on September 26, 2017 Posted in Enforcement

Federal courts continue to grapple with applying the “materiality” standard that is needed to cause a Stark Law violation or other underlying compliance matter to trigger False Claims Act liability. Although we have recently begun to gain a clearer view of what contractual requirements will not likely be viewed as material, at least one federal … Continue reading

SCOTUS strikes down Texas abortion law requiring nearby admitting privileges and imposing ASC requirements

By Yvonne Puig (US) and Eric Hoffman (US) on June 27, 2016 Posted in Enforcement

In one of the most closely watched cases of this term, a divided Supreme Court struck down Texas’s abortion law, finding that it constituted an undue burden on a woman’s right to obtain an abortion. … Continue reading

SCOTUS endorses “implied certification” FCA claims

By Justin Tschoepe (US) on June 17, 2016 Posted in Enforcement

In a closely watched decision, the U.S. Supreme Court has unanimously endorsed a version of the “implied false certification” theory of liability under the False Claims Act (“FCA”). In a decision that leaves almost as many questions unanswered as it resolved, the Court held that a material omission on a claim for payment may give … Continue reading

New USPTO subject matter eligibility (35 USC § 101) examiner guidance and life science examples

By Tamsen Barrett (US) on May 9, 2016 Posted in Regulatory

On May 5, 2016, the United States Patent and Trademark Office issued six new examples that provide guidance to Examiners and patent applicants prosecuting claims directed to life sciences subject matter (Subject Matter Eligibility Examples: Life Sciences). These examples analyze claims that are directed to several of the most contentious areas of patentable subject matter … Continue reading

Supreme Court hears arguments on “implied certification” FCA liability

By on April 20, 2016 Posted in Enforcement

On Tuesday, the U.S. Supreme Court appeared reluctant to embrace the government’s expansive view of liability under the False Claims Act (“FCA”), as it heard oral arguments in what may prove to be one of the most significant FCA cases in decades. While it is always hazardous to draw conclusions from questions at oral argument, … Continue reading

Supreme court to consider viability of False Claims Act implied certification theory

By on December 8, 2015 Posted in Enforcement

On Friday, the US Supreme Court agreed to consider two questions involving the so-called “implied certification theory” under the federal False Claims Act (FCA). First, the Court will consider whether the implied certification theory is ever viable for establishing FCA liability. If it is, the Court will also consider under what circumstances FCA liability may … Continue reading

Supreme Court holds providers cannot force States to increase Medicaid payments

By Thomas Dowdell (US) on March 31, 2015 Posted in Regulatory

The U.S. Supreme Court in a 5-4 decision on March 31 has held that providers do not have standing under either the Medicaid Act, Section 30(A), or the Supremacy Clause of the Constitution to mandate States to increase payment rates under the Medicaid program. Justice Antonin Scalia wrote the opinion for the majority in the … Continue reading