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Ingrid Martin comments in news article on pending appeals addressing causation standard in health care fraud cases

A federal appeals court is weighing competing causation standards to apply to Medicare and other health care fraud claims alleging violations of the federal Anti-Kickback Statute and False Claims Act.

Two federal judges in Massachusetts have certified interlocutory appeals to the 1st U.S. Circuit of Appeals requesting guidance on what the government must prove to successfully prosecute health care fraud cases – either the more rigorous “but for” test or a more lenient test. 

The “but for” standard requires prosecutors to prove that the alleged kickbacks caused the provision and billing of specific patient treatments, while the competing standard of proof does not require prosecutors to prove such a close, direct connection between the alleged anti-kickback violation and a medical provider’s claim for health care reimbursements.

Ingrid S. Martin, a partner at the firm, told Massachusetts Lawyers Weekly that the 1st Circuit’s ruling on the causation standard will have a substantial impact because the “but-for standard is a much more rigorous burden of proof.  It creates a higher burden for the party bringing the claim because they must make a more specific showing that there’s this connection between the [reimbursement] claim that is submitted and the alleged kickback.”

Ms. Martin focuses her practice on the intersection of criminal defense and healthcare law, including representing a broad range of healthcare providers and entities involved in health care fraud investigations.