Lexology August 1, 2023
The Federal False Claims Act (“FCA”) allows private parties to bring lawsuits in the name of the federal government against defendants who allegedly “knowingly” present a false claim to the government for payment. The question for courts has been what standard should be applied to evaluate a defendant’s “knowledge.” The US Supreme Court recently clarified that courts must examine a defendant’s subjective belief as of the time a claim is submitted.
Medicare and Medicaid offer prescription drug coverage to beneficiaries with payments that are typically capped at a pharmacy’s “usual and customary” rates. In a unanimous June decision, the Supreme Court reversed the Seventh Circuit and found the defendant pharmacies could have violated the FCA by submitting claims for reimbursement...
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