Universal Health Services v. U.S. Commonwealth of Massachusetts

Whether the “implied certification” theory is viable under the False Claims Act and, if viable, whether a government contractor’s reimbursement claim is “false” under this theory, and whether falsity requires express statements of payment?

Respondent's deceased daughter received psychiatric treatment at the Petitioner's clinic. Respondent claims that the clinic did not comply with licensing and supervision requirements set by the State and that by submitting claims to State Medicaid for reimbursement while not in compliance, the clinic submitted "false claims" under the False Claim Act. Respondent's are seeking reimbursement for payments they made for their daughter's treatment. The district court dismissed the claim. The First Circuit reversed, holding that under the "implied certification" theory, a healthcare provider's noncompliance with conditions of payment is sufficient to establish the falsity of a claim for reimbursement. The "implied certification" theory recognizes that a claim may be false where it falsely represents that the agency complied with a requirement material to payment. Petitioner argues that the First Circuit's holding conflicts with the Seventh Circuit that recently rejected the theory of "implied certification". Petitioner argues that a reimbursement claim requires an express statement that it is a condition of payment, as held by the Second and Sixth Circuits.