George Breen, a Member of the Firm in the Health Care and Life Sciences and Litigation practices, in the Washington, DC, office, was quoted in an article titled "ACA Requires That Practitioners Maintain Diligence to Stay Compliant."
Following is an excerpt:
With the initiation of the Patient Protection and Affordable Care Act, the US government is taking greater steps to investigate and protect against fraud. ...
Breen emphasized that although fraud is primarily investigated within federally-funded programs such as Medicare and Medicaid, the private insurance industry is also a target for investigation.
"It is no longer just a situation where it's just federal dollars involved. Its payments made to both federal and private insurers, and that's something that I don't think a lot of people recognize," Breen said. "The key here is the definition of a healthcare benefit program. It is not limited to federal dollars. It is any public or private plan."
Breen also emphasized that under the Affordable Care Act (ACA), the necessity of intent in order to be convicted for fraud is removed.
"No longer do you have to show that a person had a specific intent or actual knowledge in order to convict," Breen said. "So that means, if you did it, whether or not you intended to, the potential exists to be convicted."
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Board of Directors / Member of the Firm