Corporate Compliance

Tip: Implied false certification

Compliance Monitor, May 21, 2008

Prosecutors have alleged medical fraud in cases where the defendant has not made an express false certification. Under the theory of implied false certification, submission of a claim to the federal government creates an implied representation that the underlying care complies with the legal requirements necessary to bill for the service. According to this theory, to knowingly bill for services that violate applicable laws or regulations is a violation of the False Claims Act.
 
Courts are more likely to find an implied false certification where the underlying statute or regulation states the provider must comply in order to be paid.
 
Some court have construed the theory of implied false certification narrowly and have dismissed lawsuits.

This tip was adapted from The Healthcare Compliance Professional’s Guide to the False Claims Act. For more information about the book or to order your copy, click here

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