The Path from Regulator to Hunter: The Exercise of Prosecutorial Discretion in the Investigation of Physicians at Teaching Hospitals
Posted: 1 Jun 2000
This article examines the economic and cultural disruption that a law enforcement initiative can have on an industry by focusing on a recent federal law enforcement health care fraud initiative, Physicians at Teaching Hospitals ("PATH"). The PATH initiative is an apt case study: it is nation-wide, was undertaken after a deliberative process among multiple federal agencies, and is focused on a limited group of health care providers regarding few legal and reimbursement issues. Part I of the article describes the PATH initiative. Part II examines the arsenal of sanctions available to the government to pursue health care fraud, focusing on the False Claims Act, the statute utilized in the PATH initiative. Part III suggests that because the investigation and prosecution of an industry can be disruptive, care must be taken to ensure that the prosecutive initiative is warranted. The article suggests that pursuit of fraudulent healthcare providers is only one aspect of a functional health care system and that understanding when a systemic regulatory breakdown has occurred is also vital. To the extent that the current emphasis on fraud prosecution has overshadowed correction of systemic problems, the equilibrium should be reset.
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