"Presentment" Defense Rejected In Medicare FCA Case
Client Alert | 1 min read | 01.05.06
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.
Insights
Client Alert | 5 min read | 08.21.26
FTC Proposes Enforcement Policy Statement on Personalized Pricing: What Businesses Need to Know
On August 19, 2026, the Federal Trade Commission (FTC) announced a proposed Enforcement Policy Statement on personalized pricing — the practice of companies using consumers’ personal data to set individualized prices, discounts, coupons, or other incentives. The proposed statement, which is open for public comment for 30 days following publication in the Federal Register, marks a major step up in the FTC’s focus on data-driven pricing strategies and puts businesses across industries on notice that undisclosed or inadequately disclosed personalized pricing will not be tolerated. Importantly, while the proposed statement is not a binding legal requirement and does not create new legal obligations, it serves as an enforcement warning that the FTC is prepared to use its existing enforcement authority under Section 5 of the FTC Act (Section 5) and is also a potential harbinger of rulemaking. Businesses that engage in — or are considering — personalized pricing should carefully assess their disclosure practices and data collection procedures against the standards articulated in this statement.
Client Alert | 7 min read | 08.19.26
CMS’s Final Rule Bans Federal Medicaid Funding for Youth Gender-Affirming Care
Client Alert | 2 min read | 08.19.26
