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The False Claims Act is Not a Compliance Tool

Philip Betbeze, for HealthLeaders Media, May 3, 2013

But disgruntled workers are out there, and given the fact that they can share in any recovery in fraud cases, whistleblowers will continue to serve as an important tool against fraud. But perhaps the outcomes of these cases will make people who are looking for an easy payday think twice before running to the Department of Justice when an "I" is dotted wrong on a claim.

While an appeal to the Supreme Court is possible, Howard says it is unlikely, and even if appealed, the Supreme Court, of course, picks and chooses the cases on which it will rule judiciously.

Perhaps now the Department of Justice will take a similar approach in deciding which potential fraud cases to pursue.

"Many of these cases never get into court. If you're risk-averse, and face criminal penalties as well, that is huge leverage for the government," says Howard. "It's heartening to know that sanity is being restored in these types of cases. The real hope is that the government will take a more judicious view of these cases and take cases that really merit it."

While it's often claimed that the legal resources of the federal government are unlimited, that only seems true to an individual or company facing the legal might of the U.S. Government.

When you look at the big picture, the department has to make choices. Let's hope they make better ones in the future to catch those who are truly defrauding Medicare, and not through lax oversight of payment rules.


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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