{"id":890881,"date":"2016-09-06T16:17:35","date_gmt":"2016-09-06T22:17:35","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=890881"},"modified":"2016-09-07T12:23:40","modified_gmt":"2016-09-07T18:23:40","slug":"escobar-has-significant-implications-for-contractors","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/escobar-has-significant-implications-for-contractors\/","title":{"rendered":"US Supreme Court False Claims Act Decision in Escobar Has Significant Implications for Contractors"},"content":{"rendered":"

Marion T. Hack and John H. Conrad\u00a0| Pepper Hamilton LLP<\/a> | August 31, 2016<\/p>\n

On June 16, 2016, the U.S. Supreme Court ruled in the matter of Universal Health Services, Inc. v. United States ex rel. Escobar<\/em>, 136 S. Ct. 1989 (2016), changing the legal landscape for False Claims Act qui tam claims concerning the implied false certification theory of liability. This article will discuss the Escobar <\/em>holding and examine relevant considerations for contractors in light of this ruling.
\n<\/span>
\nIn Escobar<\/em>, a teenage patient received counseling under Massachusetts\u2019 Medicare program at a mental health facility, Arbour Counseling Services, which is owned and operated by a subsidiary of Universal Health Services, Inc. As part of the counseling process, the staff at Universal diagnosed the patient and prescribed medication. The patient had an adverse reaction to the medication and subsequently died of a seizure. It was later determined that four out of the five Universal employees that treated the patient were not properly licensed to provide mental health counseling, prescribe medications or offer counseling services without supervision. Specifically, the person who diagnosed the patient had her psychologist license application rejected by Massachusetts, and the person who prescribed the medication was actually a nurse who lacked authority to prescribe medication without supervision, in violation of 130 Code Mass. Regs. \u00a7 429.22, et seq. Escobar<\/em>, 136 S. Ct. at 1997-98.<\/p>\n

During this time frame, Universal submitted requests for payment to the government for its personnel under Massachusetts\u2019 Medicare program. Universal submitted these payment requests despite its knowledge that its personnel was improperly classified under the billing codes used by Universal.<\/p>\n

The False Claims Act Claim<\/u><\/a>
\n<\/u>
\nIn 31 U.S.C. \u00a7 3730(b)(1) it states, \u201cA person may bring a civil action for a violation of section 3729 for the person and for the United States Government. The action shall be brought in the name of the Government.\u201d These suits are referred to as \u201cqui tam\u201d suits. Further, 31 U.S.C. \u00a7 3729(a) provides, \u201cany person who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval . . . is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000,[1] . . . plus 3 times the amount of damages which the Government sustains because of the act of that person.\u201d<\/p>\n

Under the above provisions, the respondents in Escobar<\/em> brought a qui tam suit, alleging that Universal had violated the False Claims Act and defrauded the government in billing for services that were not properly rendered as described in the billings, while failing to disclose serious breaches related to Massachusetts\u2019 Medicare program. The respondents asserted that the government would not have reimbursed the claims had it known that it was billed for mental health services that were performed by unlicensed and unsupervised staff. Escobar<\/em>, 136 S. Ct. at 1997-98.<\/p>\n

Universal filed a motion for summary judgment to dismiss the respondents\u2019 claims. The district court granted Universal\u2019s motion \u201cbecause none of the regulations violated by Universal was a condition of payment.\u201d The U.S. Court of Appeals for the First Circuit reversed, holding that \u201cevery submission of a claim implicitly represents compliance with relevant regulations, and that any undisclosed violation of a precondition of payment (whether or not expressly identified as such) renders a claim \u2018false or fraudulent.\u2019\u201d The First Circuit also held that the \u201cregulations themselves provided conclusive evidence that compliance was a material consideration of payment.\u201d Id.<\/em> at 1998.<\/p>\n

The U.S. Supreme Court rejected both the holding of the district court and the holding of the First Circuit and remanded to the district court for further determination of the matter utilizing the new standard for implied certification claims under the False Claims Act. Id.<\/em> at 2004.<\/p>\n

New Standard for Implied False Certification Claims<\/u>
\n<\/u>
\nThe Court in Escobar<\/em> held:<\/p>\n

[T]he implied false certification theory can, at least in some circumstances, provide a basis for liability. By punishing defendants who submit \u201cfalse or fraudulent claims,\u201d the False Claims Act encompasses claims that make fraudulent misrepresentations, which include certain misleading omissions. When, as here, a defendant makes representations in submitting a claim but omits its violations of statutory, regulatory, or contractual requirements, those omissions can be a basis for liability<\/strong> if they render the defendant\u2019s representations misleading with respect to the goods or services provided.<\/p>\n

Id.<\/em> at 1999 (emphasis added).<\/p>\n

In Escobar<\/em>, Universal knowingly submitted payment applications that listed specific billing codes corresponding to certified and licensed personnel, where those individuals were not certified or licensed, thus misleading the government into paying the invoices. Id.<\/em> at 1997. The Escobar<\/em> Court clarified that the claims in the matter related to more than just demands for payment and that \u201crepresentations that state the truth only so far as its goes, while omitting critical qualifying information[,] can be actionable misrepresentations.\u201d Id.<\/em> at 2000.<\/p>\n

A critical determination in the new Escobar<\/em> standard is whether the statements made qualify as actionable misrepresentations. The Court in Escobar<\/em> provided examples of some statements that create actionable misrepresentations to guide future litigation. When a seller of property reveals that there are two new roads near a property for sale, but fails to disclose that a third potential road might bisect the property, the seller has omitted key information that would \u201cmaterially affect the value of the purchase.\u201d Id.<\/em> (citing Junius Const. Co. v. Cohen<\/em>, 257 N.Y. 393, 400 (1931)). An applicant for a position at a college makes actionable misrepresentations when his r\u00e9sum\u00e9 lists prior jobs and then retirement, but fails to disclose that his \u201cretirement\u201d involved time in prison for a $12 million bank fraud. Id.<\/em> (citing Sarvis v. Vermont State Coll.<\/em>, 172 Vt. 76, 78, 80-82 (2001)). Both of these examples point to the need for the misrepresentation to affect the basic value of the goods or services to be provided in order to be an actionable misrepresentation.<\/p>\n

The Escobar<\/em> Court also held a critical factor was that the \u201cmisrepresentation about compliance with a statutory, regulatory, or contractual requirement must be material to the Government\u2019s payment decision<\/strong> in order to be actionable under the False Claims Act.\u201d Id.<\/em> at 1996 (emphasis added). The Court also held that liability is not limited to cases where the requirements involved were expressly designated as conditions of payment. Id.<\/em> at 2001. To assist in interpreting this standard, the Court provided an example of a material misrepresentation. When a contract involves the supply of guns, and the contract does not state that the guns must actually shoot, but the supplier knows that the government routinely rescinds contracts if the guns do not shoot, the supplier has \u201cactual knowledge\u201d of the materiality of that requirement. Further, the seller\u2019s failure to appreciate the materiality of that condition would amount to \u201cdeliberate ignorance\u201d or \u201creckless disregard\u201d of the falsity of the information. Id.<\/em> at 2001-02. The Court also cited to United States ex. rel. Marcus v. Hess<\/em>, where two contractors violated a non-collusion bidding requirement and withheld that information. This was implicit false certification because the government would not have funded the subsequent payments had it known of the violation. Id.<\/em> at 2003 (citing Marcus<\/em>, 317 U.S. 5379, 543 (1943)).<\/p>\n

In the construction context, misstatements concerning the types of materials supplied or the qualifications of the individuals whose labor is billed could implicate this implied false certification theory<\/a> of the False Claims Act. For example, consider a construction contract that calls for a specific material or equipment that is required to meet specified quality or regulatory requirements. If the contractor knowingly supplies a different and lesser quality item and then bills for the government per the schedule of values including the originally specified item, then the contractor may be liable for implicitly submitting a false claim. Where a design\/build contract calls for engineering or oversight services to be performed by a licensed engineer, or where a construction management contract calls for licensed or certified personnel to perform services, and where the contractor supplies unlicensed or uncertified personnel for the positions involved, an implied false certification claim is possible. Another example is a time and material construction contract<\/a> that specifies categories of workers, depending on specific worker classifications and training levels. If the contractor provides labor that does not meet those specified classifications within the contract (e.g., supplying apprentice labor and billing for journeymen), and the contractor submits billing for personnel based on the classifications that do not match the personnel qualifications, the contractor is potentially liable for an implied false certification claim.<\/p>\n

In all of these possible scenarios posed above, contractors need to be vigilant in verifying that the labor or materials supplied by the contractor or its subcontractors do in fact meet the specifications and\/or regulatory requirements for any project. Otherwise, the contractor could be exposed to significant per act penalties and treble damages under the False Claims Act<\/a>. Should any of these issues arise, a contractor should seek assistance in resolving the matter at the earliest time to avoid or minimize the potential penalties.<\/p>\n

[1] The government revised the penalties in 2015 via 28 C.F.R \u00a7 85.3(a)(9) to a minimum of $10,781 and a maximum of $21,563 per occurrence.<\/p>\n","protected":false},"excerpt":{"rendered":"

Marion T. Hack and John H. Conrad\u00a0| Pepper Hamilton LLP | August 31, 2016 On June 16, 2016, the U.S. Supreme Court ruled in the matter of Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), changing the legal landscape for False Claims Act qui tam claims concerning the… Continue reading US Supreme Court False Claims Act Decision in Escobar Has Significant Implications for Contractors<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[3],"tags":[9794,3],"class_list":["post-890881","post","type-post","status-publish","format-standard","hentry","category-insurance-claims","tag-false-claim-act","tag-insurance-claims","entry"],"jetpack_publicize_connections":[],"yoast_head":"\nUS Supreme Court False Claims Act Decision in Escobar Has Significant Implications for Contractors - 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