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Journal Article
Federal Enforcement of Pharmaceutical Fraud under the False Claims Act, 2006–2022
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J Health Polit Policy Law (2024) 49 (2): 249–268.
Published: 01 April 2024
...Liam Bendicksen; Aaron S. Kesselheim; C. Joseph Ross Daval Abstract Context: The False Claims Act is the US federal government's primary tool for identifying and penalizing pharmaceutical fraud. The Department of Justice uses the False Claims Act to bring civil cases against drug manufacturers...
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View articletitled, Federal Enforcement of Pharmaceutical Fraud under the <span class="search-highlight">False</span> <span class="search-highlight">Claims</span> <span class="search-highlight">Act</span>, 2006–2022
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New or modified corporate integrity agreements in False Claims Act settleme...
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in Federal Enforcement of Pharmaceutical Fraud under the False Claims Act, 2006–2022
> Journal of Health Politics, Policy and Law
Published: 01 April 2024
Figure 3 New or modified corporate integrity agreements in False Claims Act settlements involving pharmaceutical manufacturers, 2006–2022. Note : CIA = corporate integrity agreement. Source : US Department of Justice press releases.
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Clinical categories of drugs named in False Claims Act settlements, 2006–20...
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in Federal Enforcement of Pharmaceutical Fraud under the False Claims Act, 2006–2022
> Journal of Health Politics, Policy and Law
Published: 01 April 2024
Figure 4 Clinical categories of drugs named in False Claims Act settlements, 2006–2022. Note : ATC = anatomical therapeutic chemical classification, B = blood and blood-forming organs, G = genitourinary system and sex hormones, H = systemic hormonal preparations (excluding sex hormones
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Journal Article
False Claims Act Liability for Overtreatment
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J Health Polit Policy Law (2020) 45 (3): 419–437.
Published: 01 June 2020
...David Howard Abstract Context: Overtreatment is costly, but is it fraud? In a growing number of False Claims Act cases, the Department of Justice has sought and received multimillion dollar settlements from providers accused of billing Medicare for unnecessary care. This article evaluates the use...
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View articletitled, <span class="search-highlight">False</span> <span class="search-highlight">Claims</span> <span class="search-highlight">Act</span> Liability for Overtreatment
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Published: 01 June 2020
Figure 1 New health care False Claims Act cases. Source : Civil Division, US Department of Justice. Fraud Statistics—Overview, www.justice.gov/opa/press-release/file/918361/download .
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Journal Article
Qui Tam Claims: Threat to Voluntary Compliance Programs in Health Care Organizations
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J Health Polit Policy Law (2000) 25 (2): 283–308.
Published: 01 April 2000
.... The DOJ's primary weapon in prosecuting health care fraud is the federal False Claims Act (FCA) of 1863 (31 U.S.C. secs. 3729–3733). Almost unique among federal antifraud provisions, the FCA may also be used by “private prosecutors” to file lawsuits on behalf of the federal government charging organizations...
Journal Article
Prospects for Enforcing Prohibitions on Off-Label Drug Promotion after United States v. Caronia : An Analysis of Litigated Cases
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J Health Polit Policy Law (2021) 46 (3): 487–504.
Published: 01 June 2021
..., 2013; July 30, 2013; November 4, 2013; November 4, 2013; December 20, 2013; January 9, 2014; February 21, 2014; September 24, 2014; October 22, 2015; February 28, 2018; May 15, 2018; December 13, 2018; June 5, 2019. The DOJ and the states' attorneys general have been using the False Claims Act...
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View articletitled, Prospects for Enforcing Prohibitions on Off-Label Drug Promotion after United States v. Caronia : An Analysis of Litigated Cases
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for article titled, Prospects for Enforcing Prohibitions on Off-Label Drug Promotion after United States v. Caronia : An Analysis of Litigated Cases
Includes: Supplementary data
Journal Article
Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond?
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J Health Polit Policy Law (2022) 47 (6): 815–833.
Published: 01 December 2022
...-increasing effect of industry payments to physicians. [email protected] [email protected] [email protected] Copyright © 2022 by Duke University Press 2022 industry payments conflict of interest Anti-Kickback Statute False Claims Act pharmaceutical industry...
Journal Article
J Health Polit Policy Law (2013) 38 (5): 1023–1050.
Published: 01 October 2013
..., and the high-risk pool being open to health coverage tax credit–eligible individuals. One point was also awarded for state-mandated coverage of infertility treatment and eating disorder coverage in the individual and small group markets. One point was also awarded for having a false claims act, antikickback...
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Journal Article
Legislative and Regulatory Options for Improving Medicare Advantage
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J Health Polit Policy Law (2023) 48 (6): 919–950.
Published: 01 December 2023
... through an RADV audit or during its course of business) must be returned to Medicare within 60 days or else constitute a false claim under the federal False Claims Act. 35 The Overpayment Rule, which in its current form requires Medicare Advantage plans to exercise “reasonable diligence” to identify...
Journal Article
Unfinished Business: How Litigation Relates to Health Care Regulation
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J Health Polit Policy Law (2003) 28 (2-3): 387–420.
Published: 01 June 2003
... during this period, particularly following budget-neutral amend-
ments to the False Claims Act that increased incentives for private parties
to file qui tam claims (actions brought by private citizens on behalf of the
government). The importance of budget considerations is magnified in
health care...
Journal Article
Ambiguous Evidence and Institutional Interpretation: An Alternative View of Electric and Magnetic Fields
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J Health Polit Policy Law (1994) 19 (1): 165–190.
Published: 01 February 1994
...
norm, the View of Risk, posits a standing interpretation of risk claims that
reinforces the bias to act or to wait. Here, the aversion to false negatives
and low threshold for evidence warranting action is linked to suspicions
that risk may be substantial and that, when in doubt, harm should...
Journal Article
Beneath the Surface of Unnecessary Surgery: A Case Study on the Limits of Existing Protections
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J Health Polit Policy Law (2019) 44 (2): 303–313.
Published: 01 April 2019
... difficult for third-party payers. NHC itself had to pay Medicare over $100 million in a settlement for False Claims Act allegations brought by three whistle blowers involving overutilization and kickbacks to physicians financially tied to NHC hospitals. Dr. A, however, had no direct financial ties to NHC...
Journal Article
As Good As It Gets? The Future of Medicare+Choice
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J Health Polit Policy Law (2002) 27 (3): 495–512.
Published: 01 June 2002
... Department (via
the OMB’s Office of Information and Regulatory Affairs) that changed
the attestations plans required to make in an effort to subject them to the
False Claims Act. In a very unusual—I would say almost unprece-
dented—move, OMB refused to allow us to publish the regulation unless
we made...
Journal Article
Medicare's Politics
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J Health Polit Policy Law (2007) 32 (2): 307–315.
Published: 01 April 2007
..., Improvement, and Moderniza-
tion Act” — seeks to understand Medicare’s recent policy changes. He
questions whether the program’s politics have been fundamentally trans-
formed by the Medicare Prescription Drug, Improvement, and Modern-
ization Act of 2003 (MMA) and whether the reform’s masked assault...
Journal Article
J Health Polit Policy Law 11825370.
Published: 28 February 2025
.../03616878-11825370. MANUUNSECDRIITPETD 25 practices through The False Claims Act, which incentivizes whistle-blowers to come forward. MedPAC shows that coding intensity accounts for more than half of overpayments to plans in recent years (MedPAC 2024), and in January 2023 CMS issued a final rule to claw...
Journal Article
State Dental Practice Acts: Implications for Competition
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J Health Polit Policy Law (1981) 5 (4): 610–630.
Published: 01 August 1981
... practices the FTC
deems potentially restrictive). The investigation is based on the Commis-
sion’s Consumer Protection Authority, rather than on antitrust. The FTC
claims that it has the authority to preempt state laws which violate the
FTC Act. The jurisdiction of the FTC under that Act...
Journal Article
AIDS Testing and Informed Consent
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J Health Polit Policy Law (1988) 13 (4): 607–621.
Published: 01 August 1988
... under the Vocational Rehabilitation Act of 1973
possible loss of federal funds under the Hill-Burton Act23and Medicare,24 and
violations of various state law and regulations. Hospitals are left with only one
realistic alternative when a patient refuses consent: they must assume the patient...
Journal Article
Communications
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J Health Polit Policy Law (1998) 23 (6): 995–1003.
Published: 01 December 1998
... for almost 80 percent of med-
ical care expenditures—substantially replicate the impact of the focused
factories elsewhere in the economy by improving quality and containing
costs. Market-Driven Health Care also relates how new sources of health
care data and convenience enable U.S. consumers to act like...
Journal Article
Informed or Misinformed Consent? Abortion Policy in the United States
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J Health Polit Policy Law (2016) 41 (2): 181–209.
Published: 01 April 2016
... the abortion procedure can be performed. These laws, often labeled “Woman's Right to Know” acts, typically require details of fetal development and information about alternatives to abortions and risks associated with abortion and pregnancy. The impact of these laws is potentially great: 66 percent of all...
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