Health-care providers facing claims of insurance fraud were dealt a blow when the United States Supreme Court, in a June 16 decision in Universal Health Services v. United States ex rel. Escobar, upheld the theory of implied false certification under the federal False Claims Act (FCA), 31 U.S.C. §3729 et seq.
The unanimous decision resolved a split of opinion among lower courts about whether a provider’s certification can be misleading by virtue of omission of important qualifying information. The affirmative response from the Supreme Court buttresses the arsenal that New Jersey prosecutors and insurers conducting business in New Jersey have to argue that failure to disclose regulatory violations and other transgressions serves as a proper basis for liability under the New Jersey Insurance Fraud Prevention Act (IFPA), N.J.S.A. 17:33A-1 et seq.
The NJ Insurance Fraud Prevention Act
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