Health Care Providers and the Public Fisc: Paradigms of Government Harm Under the Civil False Claims Act
99 Pages Posted: 9 Jan 2002
In addition to numerous program-specific penalties for failure to comply with the laws and regulations governing federal health care programs, health care providers also face the possibility of multi-million dollar liability under the Civil False Claims Act (FCA). The recent focus on fraud in federal health care programs has resulted in this basic Civil War-era statute being applied to situations that are increasingly far removed from traditional types of government fraud. This Article argues that the FCA has not been applied to the health care industry consistent with either the law's own jurisprudence or with current health care regulatory policy. This inconsistency, in turn, has important implications for the future of health care fraud enforcement. If the health care industry comes to believe that the law is being applied unfairly, the industry may question the legitimacy of the government's anti-fraud efforts - a crucial determinant of the law's ability to influence conduct through normative (rather than coercive) measures. Doubt as to the legitimacy of the government's efforts could lead to further noncompliance, requiring the use of increasingly coercive enforcement mechanisms. The result will be a contentious enforcement environment that is unlikely to advance the goal of providing cost-effective, quality health care services to patients. The Author argues that an appreciation of these issues is critical to the anti-fraud endeavor, and requires the development of practical strategies for rebuilding the relationship between government and industry.
Keywords: federal health care programs, health care fraud, false claims, regulation, enforcement
Suggested Citation: Suggested Citation