NCJ Number
69348
Journal
Fordham Urban Law Journal Volume: 5 Dated: (SPRING 1977) Pages: 493-508
Date Published
1977
Length
21 pages
Annotation
THE HISTORY AND PURPOSE OF THE FEDERAL FALSE CLAIMS ACT (FCA), AS WELL AS ITS POTENTIAL AND LIMITATIONS FOR PROSECUTING FRAUDULENT MEDICAID CLAIMS ARE DISCUSSED.
Abstract
THE ACT WAS PASSED DUIRNG THE CIVIL WAR TO INHIBIT PARTIES ATTEMPTING TO CHEAT THE GOVERNMENT. ACCORDING TO THE ACT, FALSE CLAIMS FOR GOODS AND SERVICES NOT ACTUALLY PROVIDED, SUBSTITUTION OF INFERIOR GOODS, OR EVEN PRESENTATION OF FRAUDULENTLY OBTAINED GOVERNMENT CHECKS FOR PAYMENT CAN BE PROSECUTED IN QUI TAM SUITS (I.E., A PRIVATE PLAINTIFF SUES ON BEHALF OF THE FEDERAL GOVERNMENT AND SHARES IN THE RECOVERY). FCA LIABILITY APPLIES ONLY WHEN THE FALSE CLAIM IS INTENTIONAL OR THE DEFENDANT MAKES FALSE STATEMENTS IN A DOCUMENT SUPPORTING THE CLAIM. THE DEFENDANT IS LIABLE FOR A FORFEITURE OF $2,000 FOR EACH FALSE CLAIM; THE SUM OF MONEY SUBJECT TO FORFEITURE MAY EXCEED THE DOLLAR VALUE OF FALSE CLAIMS, BUT THE NUMBER OF FALSE INVOICES DOES NOT NECESSARILY DETERMINE THE NUMBER OF FORFEITURES. FCA ALSO IMPOSES LIABILITY FOR DOUBLE THE DAMAGES SUSTAINED. ANYONE MAY BRING QUI TAM SUITS ON BEHALF OF HIMSELF AND THE FEDERAL GOVERNMENT, BUT THE PLAINTIFF MAY NOT MAINTAIN THE ACTION IF THE GOVERNMENT INTERVENES WITHIN 60 DAYS. THE ACTION IS NOT HEARD IF THE EVIDENCE OR INFORMATION WHICH FORMS THE BASIS FOR THE SUIT IS ALREADY IN GOVERNMENT POSSESSION. THE PENALTIES UNDER FCA, ESPECIALLY IMPRISONMENT, FORFEITURE, AND DAMAGES, ARE MORE STRINGENT THAN UNDER MEDICAID LAWS. FURTHERMORE, EMPLOYEES OF MEDICAL PRACTICIONERS AND LABORATORIES BRINGING FALSE CLAIMS CAN FILE SUIT, WITH FINANCIAL GAIN AS AN INCENTIVE FOR REVEALING FRAUDULENT CASES. TYPICAL MEDICAID ABUSES INCLUDE TRANSFERRING PATIENTS UNNECESSARILY FROM ONE PHYSICIAN TO ANOTHER, CHARGING FOR SEVERAL FAMILY MEMBERS INSTEAD OF THE ONE TREATED, OR SUPPLYING LESS THAT THE PRESCRIBED QUANTITY OF MEDICATION; ALL SUCH PRACTICES CAN BE PROSECUTED UNDER THE FCA. BECAUSE THE FORFEITURE AND DAMAGE EXPENSE MAY EXCEED THE FALSE CLAIMS, CRIMINAL PENALTIES ARE SEVERE, AND EMPLOYEES OF DISHONEST PROVIDERS HAVE INCENTIVES TO SUE, THE FCA PROVIDES AN EFFECTIVE DETERRENT TO MEDICAID FRAUD. EXTENSIVE FOOTNOTES ARE SUPPLIED. (KMD)