Sheehan James G, Goldner Jesse A
Saint Louis University School of Law, USA.
J Health Law. 2007 Spring;40(2):167-203.
The authors analyze existing and developing trends in healthcare fraud litigation. They first review the traditional use of the Medicare-Medicaid Anti-Kickback Statute to prosecute such fraudulent activity. They then consider newer theories that have been employed, or may be employed, in cases involving payors, middlemen, agents, and fiduciaries. These include the use of the Civil False Claims Act, the Federal Travel Act, and the Public Contracts Anti-Kickback (sometimes incorporating violations under state commercial bribery and similar state legislation to form the basis of a federal claim or prosecution). The Article then turns to a discussion and warning of attorneys' potential liability for a client's kickback arrangements. Finally, the Article takes a very brief look at relationships under Medicare Part D that may well prove to be a fertile area of problematic conduct, public and congressional scrutiny, and prosecutions utilizing some of these theories.
作者分析了医疗欺诈诉讼的现有及发展趋势。他们首先回顾了利用《医疗保险与医疗补助反回扣法》来起诉此类欺诈活动的传统做法。接着，他们考虑了在涉及付款方、中间商、代理商和受托人等案件中已被采用或可能会被采用的新理论。这些理论包括《民事虚假索赔法》《联邦旅行法》以及《公共合同反回扣法》（有时还会纳入州商业贿赂及类似州立法规定的违法行为，以此作为联邦索赔或起诉的依据）。本文随后转向讨论并警示律师因客户回扣安排可能承担的潜在责任。最后，本文简要审视了医疗保险D部分下的关系，这些关系很可能会成为问题行为、公众和国会审查以及利用上述某些理论进行起诉的一个滋生领域。
