Jack Wenik, a Member of the Firm in the Health Care and Life Sciences and Litigation practices, in the Newark office, was quoted in Wolters Kluwer Law & Business White Paper, in “False Claims Act Issues in 2014 Have Implications for 2015 and Beyond.”
Following is an excerpt:
Almost five years after enactment, the effect of the ACA provisions that have strengthened enforcement rules and provided additional funds to contain fraud and abuse activities is reflected in the increased numbers of cases being brought under the FCA as well as the multifold increase in the numbers and amounts of settlements. Over the years, the DOJ has progressively settled more cases that alleged health care provider violations of the FCA. These recent enforcement rules have had an impact on providers to settle rather than pursuing claims against them, according to Jack Wenik. …
Jack Wenik explained that the exposure for health care providers that are found liable under the FCA because of treble damages greatly influences their decision to settle rather than pursue litigation. In addition, Wenik pointed out that because CMS has not published a final rule governing the requirements that health care providers return overpayments within 60 days of discovery, the terms within the law regarding when a provider was aware or should have been aware remain ambiguous, putting a provider at risk for liability under the FCA if an overpayment is not returned timely. Wenik noted that, in the past, when allegations of fraud or false claims were brought against a health care provider, there was a stigma.