The False Claims Act: the courts move toward a rule of reason.
Physicians have been concerned that the False Claims Act may be invoked recklessly, and that they are at the mercy of whistleblowers in their own midst or from the outside who may act in revenge or pique. This article discusses the evolution of case law involving medical practices and reimbursement issues that deal with government payment regulations. It indicates the limitations that are imposed on prosecutors, as well as the liability that providers do incur under current statues.
Mustokoff
Michael M
MM
Partner, Duane Morris, LLP, One Liberty Place, Philadelphia, PA 19103-7396, USA. mmustokoff@duanemorris.com
Nelson
Carrie E
CE
D014487:Centers for Medicare and Medicaid Services, U.S.; D005607:Fraud / Q000331:legislation & jurisprudence*; D006801:Humans; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence*; D016365:Liability, Legal; D008484:Medicaid / Q000331:legislation & jurisprudence; D006278:Medicare / Q000331:legislation & jurisprudence; D018584:Physician Self-Referral / Q000331:legislation & jurisprudence*; D011216:Practice Management, Medical / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States; D035642:Whistleblowing