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Qui Tam Actions

Learn about private enforcement through qui tam actions, in which nongovernment plaintiffs may bring claims for healthcare fraud and abuse.

Transcript

The False Claims Act is a federal law that prohibits submitting false claims to the federal government, including submitting inaccurate claims for Medicare reimbursement. The government’s investigatory systems don’t necessarily uncover all false claims that violate this act. Thus, the False Claims Act also contains a financial incentive for private whistleblowers to come forward and file private enforcement actions called qui tam actions. Qui tam translates roughly to in the name of the...

Lessons

1. Welcome
  • Welcome to Healthcare Law
2. Health Insurance
  • Medicare
  • Medicaid
  • Private Rights Enforcement
  • ERISA
  • ERISA Preemption and Remedies
  • ERISA Remedies and ACA Reforms
3. The Structure of Healthcare Entities
  • The Professional Workforce
  • Forming a Healthcare Entity
  • Fiduciary Duties at Healthcare Entities
  • Tax-Exempt Status
  • Joint Ventures and Tax-Exempt Status
4. Fraud and Abuse in Healthcare
  • The False Claims Act
  • The Anti-Kickback Statute
  • Stark Law
  • Enforcement Mechanisms
  • Qui Tam Actions
5. Antitrust Issues in Healthcare
  • Overview of Antitrust Laws in Healthcare
  • Mergers and Acquisitions in Healthcare
  • Working with Competitors
  • Payers with Market Power
6. Tort Liability of Healthcare Entities
  • The Physician-Patient Relationship
  • Physician Duties Regarding Information
  • Physician Duties Regarding Clinical Care
  • Hospital and Health Plan Liability
7. Recurring Legal Issues in Patient Care
  • Reproduction and Birth
  • Organ Transplantation
  • Research Involving Human Subjects
  • The End of Life
  • Health Privacy
  • Discrimination in Healthcare
8. Public Health Law
  • The Police Power
  • Free Exercise Challenges
  • Noncommunicable Conditions