March 01, 2019

Quality Metrics: The New Frontier of False Claims Litigation?

Nina Zhang, Esq., Law Offices of Stephenson, Acquisto and Colman, Los Angeles, CA

In the shift from fee-for-service care,  the federal government has refocused its efforts on developing quality of care measures to incentivize providers -- hospitals, clinics, physicians’ offices, labs and ambulatory surgery centers alike -- to deliver care more effectively and efficiently.1 In recent years, the False Claims Act (FCA) has emerged, for better or for worse, as a quality enforcement tool. With quality of care as an ever-moving target by the federal government (with the constant development of new quality measures), the FCA has faced its share of criticism as too blunt of an instrument to regulate quality of healthcare, a matter that many argue is better left to the states under their police power.2 However, it can be argued that since the federal government is the biggest buyer of healthcare, it thus has a stake in how its monies are used. This article will explore the history of quality regulation by the federal government and the FCA and what trends should be expected in the future.

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