1. Home
  2. |Insights
  3. |Implied False Certification Split Widens

Implied False Certification Split Widens

Client Alert | 1 min read | 06.12.15

In U.S. v. Sanford-Brown, Ltd. (June 8, 2015), the Seventh Circuit rejected the implied false certification theory of False Claims Act liability, holding that alleged noncompliance with Title IV restrictions incorporated into a program participation agreement (PPA) for the Department of Education's subsidies program was insufficient to trigger FCA liability absent evidence that the defendant's application to establish initial Title IV eligibility was fraudulent. Although the majority of circuits have expressly adopted some form of the implied false certification theory of liability, the court joined the Fifth Circuit as the holdouts in rejecting the theory, explaining that "it would be . . . unreasonable for us to hold that an institution's continued compliance with the thousands of pages of federal statutes and regulations incorporated by reference into the PPA are conditions of payment for purposes of liability under the FCA."


Insights

Client Alert | 4 min read | 03.25.26

NAIC Intensifies AI Regulatory Focus: What Health Insurance Payors Need to Know

The National Association of Insurance Commissioners (NAIC) is intensifying its oversight of how insurers use AI — and the pace of regulatory activity shows no signs of slowing. Over the past several months, the NAIC has published a formal Issue Brief staking out its position on federal AI legislation, launched a multistate AI Evaluation Tool pilot aimed at examining insurers’ AI governance programs, and continued to expand adoption of its AI Model Bulletin across state lines. These developments continue a trend towards enhancing regulation; the NAIC adopted AI Principles in 2020 and a Model Bulletin in 2023 clarifying that existing insurance laws apply to AI systems and establishing expectations for governance, documentation, testing, and third-party oversight. That Model Bulletin has now been adopted in approximately 24 states....