Regulating, Guiding, and Enforcing Health Care Fraud

Abstract:     
As the numbers of health care fraud prosecutions - and the magnitude of health care fraud settlements - continue to grow, health care providers have sought advice from federal regulators on how to assure that their business relationships comply with the increasingly complex fraud laws. This governmental advice has taken the form not only of traditional efforts to regulate health care activities that may give rise to fraud, but also more creative attempts to guide industry behavior and to enforce the fraud prosecutions. This Article argues that the combination of cumbersome notice-and-comment rulemaking procedures, the proliferation of unofficial forms of fraud guidance, and the growing use of fraud litigation as a regulatory strategy have created an increasingly untenable situation for the health care industry. Alleviating these problems requires a focus on regulatory clarity as a necessary precondition for a legitimate enforcement framework: demanding clear rules to govern the conduct of health care providers, backed by substantial penalties for clear violations.

Number of Pages in PDF File: 42

Accepted Paper Series