The U.S. Supreme Court on Friday agreed to consider reviving two lawsuits accusing pharmacy operators of overbilling government health insurance programs for prescription drugs, a dispute that could have broad implications for whistleblowers and the government's ability to go after fraud.
The key question in both cases is whether companies can shield themselves from whistleblower fraud lawsuits by pointing to an "objectively reasonable" interpretation of the law that supports their conduct - regardless of whether they actually believed that interpretation in good faith at the time.
in 2018, argued in lawsuits filed by whistleblowers accusing them of defrauding Medicare and Medicaid. The Chicago-based 7th U.S. Circuit Court of Appeals agreed, granting judgment in favor of the companies. The whistleblowers appealed to the Supreme Court. The whistleblowers said that federal law required pharmacies to bill Medicare and Medicaid based on "usual and customary" prices that they actually charge customers. They also said both companies knew they were defrauding the government and worked to conceal their pricing practices.
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