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Eye on Enforcement

First Circuit Holds That Labs Can Generally Rely on a Doctor’s Order as Proof of Medical Necessity Under the False Claims Act

By Sarah Q. Wirskye, Bethanie Livernois & Lexie Alexander
January 20, 2026
First Circuit Holds That Labs Can Generally Rely on a Doctor’s Order as Proof of Medical Necessity Under the False Claims Act

Addressing an issue of first impression, the First Circuit has clarified the burden to satisfy the knowledge element required in False Claims Act (FCA) cases in the context of laboratory testing and Medicare fraud. The Medicare Act permits reimbursement of…

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