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Ambiguity Remains After Escobar

Client Alert | 1 min read | 11.09.16

In U.S. ex rel. Nelson v. Sanford-Brown Ltd. (Oct. 24, 2016), the Seventh Circuit, applying the materiality standard articulated by the Supreme Court in Escobar (discussion available here), held that the relator’s allegations that the college inflated grades and job placement figures and paid bonuses to employees for recruitment to fraudulently obtain federal student aid money failed because there was no evidence that the college had made any express or implied representations with its claims for payment or evidence that the government’s payment decision would likely have been different had it known of the alleged misrepresentations. In contrast, the Eighth Circuit in U.S. ex rel. Miller v. Weston Educ. Inc. (Oct. 19, 2016) held that similar allegations withstood summary judgment (as noted by C&M here), suggesting that the Supreme Court’s decision in Escobar may not have resolved the circuit split on implied certification after all.

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Client Alert | 6 min read | 04.29.26

CMS Seeks to Expand Interoperability Requirements to Drug Pre-Authorization (FAQ)

On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (2026 CMS Interoperability Standards and Prior Authorization for Drugs, or CMS-0062-P) outlining the agency’s plans to impose new interoperability requirements on payors participating in certain Medicare and Medicaid programs. As described by the agency in a recent press release, the proposed rule “builds on” prior rulemaking by clarifying and enhancing interoperability requirements for payors’ prior authorization processes, specifically those associated with coverage requests for pharmaceutical therapies....