False Claims: The Coordinated Exploitation of the United States Government by the Healthcare Industry.

Abstract

The False Claims Act (FCA) has a long-standing history of protecting the United States government from being defrauded by merchants and other parties submitting claims for repayment. Affording Americans who have enrolled in Medicaid and Medicare expansion plans the same protection afforded to the federal government will allow for action to be brought to prevent large hospital networks from engaging in price-fixing behaviors. Implementing this change will have the effect of reducing healthcare prices for all Americans. Applying the False Claims Act at the price-fixing level will have the largest affect; however, it is still important to iron out procedures for individual claims involving factual and legal falsity. Although the different requirements established for the two types of falsity at first glance appear to be contradictory to each other, it is clear there is no overlap or split between factual and legal falsity. However, if large scale litigation were brought under FCA liability, it is important for Congress or the Supreme Court to offer lower courts guidance in applying these distinct standards. Establishing requirements for FCA liability under factual and legal falsity will allow for healthcare providers to make plans to adhere to the guidance. This change will have the effect of reducing unnecessary healthcare treatments and spending, passing on financial and physical health benefits to the American people.