August 01, 2015

The Three-Headed Monster of Healthcare Fraud Enforcement: The False Claims Act, Stark Law, and the Anti-Kickback Statute

John W. Nisbett

Last year, the U.S. Department of Justice obtained record recoveries from civil cases involving fraud and false claims. The three-headed monster of healthcare fraud prevention and enforcement is the False Claims Act (FCA), Stark Law (Stark), and the Anti-Kickback Statute (AKS). These rigid enforcement laws are enough to scare any owner/operator of a business providing healthcare services in the United States. Even scarier is that under the qui tam provisions of the FCA, private individuals may file enforcement actions on behalf of the government if they learn of fraudulently submitted claims that are otherwise undetected. Known as “relators” (and colloquially referenced as whistleblowers), these individuals may receive up to 30 percent of any successful recovery. In 2015, the broadened statutory bases of FCA recovery established by the Patient Protection and Affordable Care Act (ACA) have become more apparent, resulting in continued proliferation of healthcare fraud recovery actions.

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