超越反回扣法规:新的实体,新的理论在医疗欺诈起诉。

Journal of health law Pub Date : 2007-01-01
James G Sheehan, Jesse A Goldner
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引用次数: 0

摘要

作者分析了医疗欺诈诉讼的现状和发展趋势。他们首先回顾了医疗-医疗补助反回扣法规对此类欺诈行为的传统使用。然后,他们考虑在涉及付款人、中间人、代理人和受托人的案件中已经使用或可能使用的较新的理论。其中包括使用《民事虚假申报法》、《联邦旅行法》和《公共合同反回扣法》(有时将违反州商业贿赂和类似州立法的行为纳入联邦索赔或起诉的基础)。文章然后转向讨论和警告律师对客户的回扣安排的潜在责任。最后,本文简要介绍了医疗保险D部分下的关系,这很可能被证明是问题行为、公众和国会审查以及利用这些理论起诉的肥沃地区。
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Beyond the anti-kickback statute: new entities, new theories in healthcare fraud prosecutions.

The authors analyze existing and developing trends in healthcare fraud litigation. They first review the traditional use of the Medicare-Medicaid Anti-Kickback Statute to prosecute such fraudulent activity. They then consider newer theories that have been employed, or may be employed, in cases involving payors, middlemen, agents, and fiduciaries. These include the use of the Civil False Claims Act, the Federal Travel Act, and the Public Contracts Anti-Kickback (sometimes incorporating violations under state commercial bribery and similar state legislation to form the basis of a federal claim or prosecution). The Article then turns to a discussion and warning of attorneys' potential liability for a client's kickback arrangements. Finally, the Article takes a very brief look at relationships under Medicare Part D that may well prove to be a fertile area of problematic conduct, public and congressional scrutiny, and prosecutions utilizing some of these theories.

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