title: Nursing homes face quality-of-care scrutiny under the False Claims Act.
abstract: The Federal government has brought a series of civil actions against nursing home operators for alleged violations of the Federal False Claims Act. According to government prosecutors, if a nursing home submits Medicare or Medicaid claims for care the government considers substandard, the claims are false for that reason alone. However, the government's theory ignores the fact that the detailed Federal statutes and regulations that govern nursing homes, as well as the agencies that enforce them (the "regulatory enforcement scheme"), allow homes that have been found to provide substandard care to continue receiving Medicare and Medicaid payment while they correct their deficiencies. Until recently, most of the cases had settled, and the government's theory had not been addressed in a published court decision. In a recent case, however, a Federal judge refused to grant the defendant facility's motion to dismiss and permitted the government's case to proceed.
authors.affiliation: Litigation and Employment Business Unit, Manatt, Phelps & Phillips, LLP, Los Angeles, California, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Landsberg
authors.forename: T D
authors.initials: TD
authors.lastname: Keville
mesh_terms: D002568:Certification; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence*; D019983:Guideline Adherence / Q000331:legislation & jurisprudence*; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008134:Long-Term Care / Q000592:standards; D008484:Medicaid / Q000592:standards; D006278:Medicare / Q000592:standards; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards*; D011787:Quality of Health Care / Q000331:legislation & jurisprudence*; D014481:United States