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."

Jump to Page

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.