False Claims Act Liability: When Do Claims for Health Care Reimbursement 'Result From' Anti-Kickback Statute Violations?

The Department of Justice and Department of Health and Human Services recently renewed their False Claims Act (FCA) Working Group, reinforcing scrutiny of health care and life sciences companies, with a focus on Anti-Kickback Statute (AKS) violations. A circuit split has developed over whether FCA liability requires strict “but-for” causation between AKS violations and reimbursement claims, or only a looser “link.” Most circuits now favor the more stringent “but-for” standard, while the 3rd Circuit continues to apply the link test. As courts move toward the stricter view, DOJ and relators are increasingly relying on false certification theories to pursue FCA claims tied to AKS violations.