The Supreme Court voted unanimously to reopen two false claims cases, issuing an opinion that could expand antifraud statute scope, Medscape reported June 13.
The move could increase scrutiny for physicians that bill government-funded insurance programs, according to the report.
The cases focus on the allegations that SuperValu and Safeway pharmacies defrauded the government by overcharging Medicaid and Medicare for prescription drugs.
The whistleblower suits allege that Safeway and SuperValu offered patients discounted cash pricing and submitted the retail cost to insurers. Whistleblowers said customers rarely paid the retail price, and pharmacies knowingly misreported the sales information.
If a person knowingly submits false claims or suspects the claim is incorrect but doesn't verify the information, they are liable under the False Claims Act. The ruling, according to the report, affirms that a person is liable if they chose not to ask for clarification.
According to the report, companies have previously been known to argue that billing policies are ambiguous so they couldn't be liable, despite not asking for clarification.
In these suits, the lower court ruled that the pharmacies could not have known because there was no explicit guidance on discounted price models. Whistleblowers appealed, and the Supreme Court said the defendants were liable.
Medscape advises providers to review their billing policies and conduct audits.