Carrie Valiant Quoted in Article About Payers Role in Fraudulent Claims

Managed Healthcare Executive

Carrie Valiant, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, office, was quoted in an article titled "Payers Must Combine Resources to Red Flag Fraudulent Claims."

Following is an excerpt:

Carrie Valiant, a partner at Epstein Becker Green who specializes in healthcare fraud and abuse, appreciates the need to crack down on fraud. She's the co-author of "Legal Issues in Healthcare Fraud and Abuse."

"But there needs to be balance and established rules so good providers are not dissuaded from participating in various programs that are essential to the success of healthcare reform," she says.

The possibility of disgruntled employees lodging specious complaints against a former employer is one concern. Another is how to determine whether shared data are reliable and what agency or authority will make those determinations.

The fear of a provider being suspended without due process is another reason to be cautious, Valiant advises.

While the idea of expanding the federal database to include private payers has its appeal, Valiant says that government rules on eligibility and payment don't mirror those of private plans, which can create its own issues.

"I've had clients thrown out of the federal healthcare system because they forgot to file a piece of paper that they moved," Valiant says. "It used to be easy to get reinstated, but not any more."