Medicare program

False Claims Act As a Tool for Pursuing Medicare Fraud and Improper Billing The FCA “is arguably the single most potent weapon in the federal health care law enforcement arsenal” (Barber et al. , 2004, p. 135). Its original design was intended to safeguard the government from financial losses resulting from fraudulent wartime billing by contractors or other entities (Engleberg, 2004, p. 527; Kikkawa, 1998, p. 2). Although the Medicare program was first implemented over 100 years after the FCA was passed, the FCA is used frequently to litigate cases of suspected Medicare fraud.

This became particularly true in the mid-1980s, which saw an accelerated use of the FCA as a tool to combat health care fraud. At that time, Congress was especially concerned about evidence of “rampant fraud and government acquiescence,” while the national debt continued to grow (Munich & Lane, 1999, p. 3). Examples of government waste included embarrassing reports about wasteful overpayments to defense contractors for $500 coffee pots and other items (Paschke, 1994, p. 167). Spurred on by this negative publicity and growing fiscal concerns, Congress sought new methods to combat fraud, waste, and abuse.

One such method was revising the FCA. In 1986, Congress made a series of amendments to the FCA text. Paschke described the process through which these amendments were created as follows: The old, “crippled” law was stumbled upon by the Co-director of the Center for Law and Public Interest, John Phillips, who recognized the potential it had for decreasing Government defraudment and providing revenue for public interest work. After further inquiry, the Center for Law and Public Interest sent a series of proposed amendments to Senator Charles Grassley and Congressman Howard Berman.


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