Brennan John T, Paddock Michael W
J Health Life Sci Law. 2008 Oct;2(1):37, 39-71.
The False Claims Act (FCA) is established as the federal government's prosecutorial weapon of choice in combating fraud and abuse in healthcare today. The FCA's substantial penalties present potential defendants with daunting risks should they elect to put the government's case to the test at trial. The government and relators have sought to extend the contours of the FCA's coverage beyond actions involving "factually false" claims to pursue cases involving alleged violations of other laws that give rise to "legally false" claims. This article considers the viability of the legal bases upon which the FCA may be used in this regard, with specific attention to the appropriateness of implied and express false certification liability theories to punish violations of the Medicare Conditions of Participation. It is the thesis of this article that on both sound legal and policy grounds, the FCA is not an appropriate tool for punishing the failure to provide quality care, unless the quality of care provided is so substandard as to result in a factually false claim (e.g., the services billed were not actually rendered).
《虚假索赔法》（FCA）如今已成为联邦政府打击医疗保健领域欺诈和滥用行为的首选检察武器。如果潜在被告选择在审判中对政府的案件进行抗辩，FCA的巨额罚款将给他们带来巨大风险。政府和举报人试图将FCA的覆盖范围从涉及“事实上虚假”索赔的行为扩大到涉及涉嫌违反其他法律从而产生“法律上虚假”索赔的案件。本文探讨了在这方面使用FCA的法律依据的可行性，特别关注默示和明示虚假认证责任理论在惩罚违反医疗保险参与条件行为方面的适用性。本文的论点是，基于合理的法律和政策依据，FCA并非惩罚未能提供优质护理行为的合适工具，除非所提供的护理质量极低以至于导致事实上虚假的索赔（例如，所计费的服务实际上并未提供）。
