title: The false claims act and the eroding scienter in healthcare fraud litigation.
abstract: This article addresses the federal government's expansive methods in tackling healthcare fraud, particularly in misapplying the False Claims Act. Although tasked with the obligation to curtail the fraudulent submission of Medicare & Medicaid claims, the U.S. government must rein in the current trend to utilize the False Claims Act against smaller medical providers. As the Act's original focus has ebbed in significance, the government has increasingly applied the False Claims Act to circumstances that do not evince actual fraud. In doing so, federal courts have effectively eroded the statute's critical scienter requirement. The federal common-law doctrines of "payment by mistake" and "unjust enrichment" adequately address the payment of non-fraudulent, albeit false, Medicare & Medicaid claims. Yet the federal government pursues these appropriate remedies only rarely and in the alternative, essentially when the government fails under the False Claims Act. Thus, this article argues for reform, calling for a clearer delineation between remedial and punitive measures. In cases involving smaller medical providers, courts should strictly limit the False Claims Act to those instances where fraud is clearly manifest.
authors.affiliation: University of Houston Law Center, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Doan
mesh_terms: D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D008484:Medicaid; D006278:Medicare; D014481:United States