Implications for Healthcare Compliance with Supreme Court’s SuperValu Decision

The Supreme Court’s 2023 decision in United States ex rel. Schutte v. SuperValu involved SuperValu and Safeway allegedly overbilling Medicare and Medicaid for prescription drugs. The Supreme Court rejected the idea that defendants could claim ignorance due to an objectively reasonable interpretation of the law. Instead, it focused on defendants’ actual knowledge and beliefs.

According to an article written by the Health Care Compliance Association, the decision impacts future FCA cases, shifting the focus to defendants’ intent and potentially increasing litigation and liability risks. Healthcare organizations and compliance professionals must now prioritize due diligence to avoid improper claims submission and FCA liability.

The article highlights key takeaways including the removal of the “objective reasonable interpretation” defense, the emphasis on subjective intent, and the clarification of “deliberate ignorance” and “reckless disregard.” Healthcare organizations face significant liability if they fail to address compliance risks effectively consider the implications for healthcare compliance.

This ruling has influenced numerous cases since its issuance, leading to reversals of earlier dismissals and raising the stakes for healthcare organizations. Compliance professionals must adapt to the new standards to manage compliance risk effectively.