False Claims Act may reach managed care organizations.
The Federal False Claims Act (FCA) applies to managed care organizations and their networks, despite the fact that managed care organizations do not submit traditional fee-for-service claims to the Federal government and the providers in their networks do not engage in direct dealings with the government. The FCA can be adapted to apply to many types of arrangements, even those in which the participants do not intend to defraud the government, with consequent implications for managed care administrators and financial managers. The combination of growing publicity regarding the use of the FCA in managed care settings and the government's large awards for whistle-blowers makes it likely that the FCA increasingly will be invoked to combat fraud in managed care organizations that contract with Federal healthcare programs.
Slade
Shelley R
SR
Vogel & Slade, LLP, Washington, D.C., USA. ssladeesq@aol
D030881:Disclosure; D005376:Financial Management / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D006077:Government Agencies; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008329:Managed Care Programs / Q000191:economics* / Q000331:legislation & jurisprudence*; D020398:Medicare Part C / Q000331:legislation & jurisprudence; D014481:United States