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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 | 7 min read | 01.30.26

CMS Proposes CY 2027 Growth Rate and Changes to Risk Adjustment for Medicare Parts C and D

On January 26, 2026, the Centers for Medicare and Medicaid Services (CMS) circulated the Calendar Year (CY) 2027 Advance Notice to communicate proposed changes to Medicare Advantage (MA) capitation rates and Parts C and D payment policies.  The changes are expected to be finalized in April 2026 but may be delayed. The following is a summary of the most significant proposals, with further details below:...