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
Leading insight on legal developments in the healthcare and life sciences industries.
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 …
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…
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…
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…
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.
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 rise to liability where two conditions are met:
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 under 35 U.S.C. § 101, including vaccines, methods for diagnosing and treating, nature-based products including mixtures, methods for genetic screening, and machines and processes that are alleged to be founded on a natural law.
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, some of the questioning indicated that the Court may offer qualified support for some kind of “implied certification” theory of legal falsity that falls short of the government’s broad position. The case is Universal Health Services v. U.S. ex rel. Escobar. For healthcare providers and government contractors, the decision could radically alter the landscape of potential liability for false claims.
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…
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…