Trends in 2 Major Liability Risks in the Healthcare Industry

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A new white paper entitled "Managing the Growing Risk of FCA Liabilities," provides insight into trends in government enforcement of the False Claims Act and antitrust laws.

The report was written by Keith Lavigne, senior vice president at ACE USA Professional Risk — a multiline property and casualty insurance company — and attorneys from the law firm of Bass, Berry & Sims in Nashville, Tenn.

In recent years, the government has increased its focus on FCA enforcement. In 2012 alone, the government recovered $5 billion in civil FCA enforcement actions.

To help reduce FCA liability, the report advises healthcare organizations submitting claims to Medicare for reimbursement to not only be mindful of the government's continued emphasis on FCA enforcement but to also implement and review compliance measures on a regular basis to ensure accurate billing. 

The government is also more intensely focused on antitrust law enforcement efforts. The report states, "We have entered into a new age of antitrust liability for healthcare providers." Healthcare organizations open themselves up to antitrust litigations anytime they do anything that unreasonably restrains competition.

To help avoid antitrust liability, the report advises healthcare organizations to be especially vigilant when joint contracting with health plans, because that is an area of strong enforcement focus.

There is also intense enforcement focus on "most favoured nations" pricing clauses and bundled pricing of multiple services, according to the report.

More Articles on the False Claims Act:

15 Recent Healthcare Lawsuits, Settlements
Judge Issues Sanctions Against Halifax For Destroying Files
Court Dismisses $50M False Claims Act Case Against Huron Consulting Group

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