Faunce Thomas, Urbas Gregor, Skillen Lesley, Smith Marc
ANU College of Law, Fellows Road, Acton, Canberra, ACT 0200, Australia.
J Law Med. 2010 Dec;18(2):302-15.
The Australian Federal Government expends increasingly large amounts of money on pharmaceuticals and medical devices. It is likely, given government experience in other jurisdictions, that a significant proportion of this expenditure is paid as a result of fraudulent claims presented by corporations. In the United States, legislation such as the False Claims Act 1986 (US), the Fraud Enforcement and Recovery Act 2009 (US), the Stark (Physician Self-Referral) Statute 1995 (US), the Anti-Kickback Statute 1972 (US), the Food, Drug and Cosmetic Act 1938 (US), the Social Security Act 1965 (US), and the Patient Protection and Affordable Care Act 2010 (US) has created systematic processes allowing the United States Federal Government to recover billions of dollars in fraudulently made claims in the health and procurement areas. The crucial component involves the creation of financial incentives for information about fraud to be revealed from within the corporate sector to the appropriate state officials. This article explores the opportunities for creating a similar system in Australia in the health care setting.
澳大利亚联邦政府在药品和医疗设备上的支出越来越多。鉴于政府在其他司法管辖区的经验，这笔支出中很可能有很大一部分是因企业提出的欺诈性索赔而支付的。在美国，诸如1986年《虚假索赔法》（美国）、2009年《欺诈执法与追讨法》（美国）、1995年《斯塔克（医生自我转诊）法规》（美国）、1972年《反回扣法规》（美国）、1938年《食品、药品和化妆品法》（美国）、1965年《社会保障法》（美国）以及2010年《患者保护与平价医疗法案》（美国）等立法建立了系统程序，使美国联邦政府能够追回在医疗和采购领域欺诈性提出的数十亿美元索赔。关键组成部分包括建立经济激励机制，促使企业内部向相关州官员披露欺诈信息。本文探讨了在澳大利亚医疗保健领域建立类似系统的机会。
