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In the past 5 years how has fraud and abuse affected the U.S. healthcare system
Health care fraud and abuse paper introduction
Health care fraud and abuse paper introduction
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False Claims Act and Pharmaceuticals
Health care fraud cases continue to be problematic for health care systems and providers across the United States. According to Pozgar (2012), these cases not only pose financial burdens on the accused, but may also lead to unnecessary risks to patients. A violation against the Federal False Claims Act, 31 U.S.C. §§ 3729-33, is one example of health care fraud that often enters into a settlement agreement. It is important to mention violations against the Federal False Claims Act, 31 U.S.C. §§ 3729-33, often allude to physician kickbacks as well (a violation against the Anti-Kickback Statute).
The following paper discusses the Federal False Claims Act, 31 U.S.C. §§ 3729-33 in more detail. While such violations may involve various types of health care providers, focus is placed on the applicability of the law within the pharmaceutical sector of health care. The roles and responsibilities of a health care administrator within the pharmaceutical sector are also discussed considering the impact this entity may play in preventing such violations (e.g., knowledge of law, how it impacts daily operations, consulting with legal entities, regulatory compliance, etc.).
False Claims Act and Requirements (Summary)
To gain a better understanding of the Federal False Claims Act, 31 U.S.C. §§ 3729-33, one must first consider when and how the law was established. According to the United States Department of Justice (DOJ) (n.d.), this law was first “enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding the Army” (p. 1). Since its original presentation, the law has been amended – significant changes were made in 1986, followed by three more ame...
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...cesses to report the offense to relevant authorities in appropriate circumstances. (p. 7-9)
The OIG (2003) indicates the above elements should not be considered a comprehensive compliance program, but rather guidelines for the pharmaceutical sector of health care.
Conclusion
The evidence presented suggests violation of the Federal False Claims Act, 31 U.S.C §§ 3729-33 not only imposes financial burdens on pharmaceutical companies and manufacturers, but may also jeopardize the reputation and operation of such entities. Hence, as an administrator within the pharmaceutical sector of health care, one must remain cognizant of the law and implications for violation. Efforts placed in ensuring regulatory compliance through development of a corporate compliance program, as well as adhering to the standards set forth by the PhRMA may help reduce cases of health care fraud.