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"Presentment" Defense Rejected In Medicare FCA Case

Jan.05.2006

The developing case law interpreting the False Claims Act's imposition of liability on anyone who "knowingly presents, or causes to be presented" a false claim to the federal government should especially interest any company whose "government" business involves directly invoicing someone other than the government itself -- e.g., a grantee, a state or local government, a fiscal intermediary, or a prime contractor -- even though federal funds may ultimately be included in the payment. Another recent decision in this line, United States v. Squire , 2005 WL 3470297 (N.D. Illinois Dec. 12, 2005), denied a Medicare provider's motion to dismiss, holding that the provider may "cause" a false claim to be "presented" by means of a convoluted pathway, where the provider's requests for payment are submitted directly to a "fiscal intermediary" (administrative services contractor) which determines the correct amount of the provider's compensation and then authorizes a commercial bank to draw down a daily total from the Medicare trust funds held by the Federal Reserve Bank, a daily total which includes -- among a great many other things -- an amount used to compensate the provider.

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