Medical Error as False Claim
23 Pages Posted: 2 Oct 2001
Abstract
Medical error and health care fraud are hot topics these days. The centerpiece of current anti-fraud efforts is the Civil False Claims Act (FCA), a powerful Civil War-era statute that prohibits the knowing submission of false or fraudulent claims to the federal government. Recently, the FCA has been extended beyond the traditional government fraud context to cases alleging violations of Medicare and Medicaid quality requirements. Given this interest in quality issues and the recent attention to medical errors, it is logical to ask whether the FCA can (and should) be used to address errors in care provided to federal health care program beneficiaries. Medical errors might present an attractive target for anti-fraud efforts because they involve harm to individual patients, potential violation of federal regulations, systemic quality problems, a wide pool of potential private plaintiffs, and intense pressure to settle fraud allegations. Yet Professor Krause argues that the balance ultimately weighs against applying the FCA to medical errors, for reasons that include the effect of clinical uncertainty on quality, the difficult proof such cases would entail, the importance of developing a coherent body of FCA case law, and the uses to which the recovered funds would be put.
Keywords: medical error, health care fraud, false claims
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