SCOTUS Vacates First Circuit Ruling, Holds Scope of FCA Materiality Requirement is "Demanding"

U.S. Supreme Court False Claims Act / FIRREA

On June 16, the United States Supreme Court issued an opinion vacating a First Circuit ruling on the grounds that the appellate court’s interpretation of the False Claims Act’s (FCA) materiality requirement to include any statutory, regulatory, or contractual violation is overly broad. Universal Health Servs., Inc. v. U.S. ex rel. Escobar, No. 15-7 (U.S. June 16, 2016). In a unanimous opinion delivered by Justice Clarence Thomas, the Court held that the implied false certification theory can be a basis for liability under the FCA when (i) the defendant submits a claim for payment to the government that makes specific representations about the goods or services provided; and (ii) the defendant’s failure to disclose noncompliance with material statutory, regulatory, or contractual requirements make its representations misleading half-truths. However, the Court did not adopt the appellate court’s expansive interpretation of what constitutes a “false or fraudulent claim” under this theory, concluding:

A misrepresentation cannot be deemed material merely because the Government designates compliance with a particular statutory, regulatory, or contractual requirement as a condition of payment. Nor is it sufficient for a finding of materiality that the Government would have the option to decline to pay if it knew of the defendant’s noncompliance. Materiality, in addition, cannot be found where noncompliance is minor or insubstantial.

In Escobar, respondents filed a qui tam suit against a health services clinic, alleging that it violated Massachusetts Medicaid regulations, which were designated as express conditions of payment for the Medicaid program, by allowing unqualified staff to provide mental health counseling and knowingly misrepresenting compliance with the regulations when submitting reimbursement claims. According to respondents, a misrepresentation can be deemed material so long as the defendant “knows that the Government would be entitled to refuse payment were it aware of the violations.” The Supreme Court disagreed and held that, under 31 U.S.C.  §3729(a)(1)(A), the FCA “does not adopt such an extraordinary expansive view of liability.” Rather, the Court reiterated that the materiality standard is demanding and the key determinant is whether the misrepresentation, i.e., the defendant’s failure to comply with particular statutory, regulatory or contractual requirements, is likely to influence the government’s payment decision. Because the First Circuit had not applied this standard, the Court remanded the case for the lower courts to reconsider whether the materiality threshold was met.