Landsberg B S, Keville T D
Litigation and Employment Business Unit, Manatt, Phelps & Phillips, LLP, Los Angeles, California, USA.
Healthc Financ Manage. 2001 Jan;55(1):54-8.
The Federal government has brought a series of civil actions against nursing home operators for alleged violations of the Federal False Claims Act. According to government prosecutors, if a nursing home submits Medicare or Medicaid claims for care the government considers substandard, the claims are false for that reason alone. However, the government's theory ignores the fact that the detailed Federal statutes and regulations that govern nursing homes, as well as the agencies that enforce them (the "regulatory enforcement scheme"), allow homes that have been found to provide substandard care to continue receiving Medicare and Medicaid payment while they correct their deficiencies. Until recently, most of the cases had settled, and the government's theory had not been addressed in a published court decision. In a recent case, however, a Federal judge refused to grant the defendant facility's motion to dismiss and permitted the government's case to proceed.
联邦政府已对养老院经营者提起一系列民事诉讼，指控他们违反了联邦《虚假索赔法》。据政府检察官称，如果一家养老院提交了政府认为不符合标准的护理的医疗保险或医疗补助索赔，仅因这一原因，这些索赔就是虚假的。然而，政府的理论忽略了这样一个事实，即管理养老院的详细联邦法规以及执行这些法规的机构（“监管执法体系”）允许那些被发现提供不合格护理的养老院在纠正缺陷的同时继续获得医疗保险和医疗补助支付。直到最近，大多数案件都已和解，而政府的理论尚未在已公布的法院判决中得到探讨。然而，在最近的一个案件中，一名联邦法官拒绝批准被告机构的驳回动议，并允许政府的案件继续进行。
