A Patient-Centered Approach to Health Care Fraud Recovery

Abstract

This article addresses the disposition of proceeds from health care fraud settlements and explores mechanisms to direct some portion of those proceeds to injured patients. Currently, funds recovered through health care fraud enforcement are distributed to the Medicare Trust Fund, to the investigating federal agencies, and to private parties who initiate suits on the government's behalf under the civil False Claims Act - but rarely to patients who have been harmed by the conduct. While returning funds to the federal Treasury helps to assure that the federal health care programs remain solvent, it does not directly benefit injured individuals. Moreover, this approach stands in marked contrast to recent efforts to make the United States health care system more "patient-centered." After analyzing the conceptual framework of this system, the article outlines recent examples of more consumer-oriented health care fraud settlements and explores whether common consumer protection compensation strategies might be adopted more broadly in the health care fraud context.