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COFC Grants Summary Judgment on Statutory and Implied-in-Fact Contract Claims in ACA Litigation

Client Alert | 1 min read | 02.20.19

On February 15, the COFC granted summary judgment in Maine Community Health Options v. United States (a C&M case), in which the Plaintiff sought to recover “cost-sharing reduction” (CSR) payments pursuant to Section 1402 of the Affordable Care Act. Under the CSR program, health insurers providing insurance on the exchanges are required to reduce certain individuals’ cost-sharing obligations, and the government is required to reimburse the insurer for the cost-sharing reductions. The health plan argued that the government’s payment obligation was mandatory under the terms of statute and moved for summary judgment. The government, cross-moving to dismiss, argued that the government did not have a mandatory payment obligation because Congress did not specify a source of appropriations. Following COFC precedent including Montana Health (discussed here), the court granted the health plan’s motion and denied the government’s cross-motion, holding that the obligation to make payment under a money-mandating statute is distinct from the appropriation used to fund it, and that the lack of an appropriation merely restricts the government’s agents (here, HHS), but does not negate the United States’ statutory payment obligation. The court also found in favor of the plaintiff under a breach of implied-in-fact contract theory, finding significant the quid-pro-quo nature of the CSR program, where health plans are reimbursed by the government for cost-sharing reductions they are statutorily required to make.

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Client Alert | 5 min read | 12.12.25

Eleventh Circuit Hears Argument on False Claims Act Qui Tam Constitutionality

On the morning of December 12, 2025, the Eleventh Circuit heard argument in United States ex rel. Zafirov v. Florida Medical Associates, LLC, et al., No. 24-13581 (11th Cir. 2025). This case concerns the constitutionality of the False Claims Act (FCA) qui tam provisions and a groundbreaking September 2024 opinion in which the United States District Court for the Middle District of Florida held that the FCA’s qui tam provisions were unconstitutional under Article II. See United States ex rel. Zafirov v. Fla. Med. Assocs., LLC, 751 F. Supp. 3d 1293 (M.D. Fla. 2024). That decision, penned by District Judge Kathryn Kimball Mizelle, was the first success story for a legal theory that has been gaining steam ever since Justices Thomas, Barrett, and Kavanaugh indicated they would be willing to consider arguments about the constitutionality of the qui tam provisions in U.S. ex rel. Polansky v. Exec. Health Res., 599 U.S. 419 (2023). In her opinion, Judge Mizelle held (1) qui tam relators are officers of the U.S. who must be appointed under the Appointments Clause; and (2) historical practice treating qui tam and similar relators as less than “officers” for constitutional purposes was not enough to save the qui tam provisions from the fundamental Article II infirmity the court identified. That ruling was appealed and, after full briefing, including by the government and a bevy of amici, the litigants stepped up to the plate this morning for oral argument....

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