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Faculty Publish on False Claims Act Cases Impact on Rural Providers

by Leah Sherwood

Andy Hyer

Andy Hyer, instructor in the Department of Community and Environmental Health, published a paper titled, “The Good, the Bad, and the Ugly: The Unnecessarily Broad Impact of Qui Tam Civil False Claims Act Cases on Rural Health Care Providers,” in Health-Matrix.

The article is about how the Federal Claims Act (FCA) provides strong financial incentives to whistleblowers, who can bring FCA cases against health care providers on the government’s behalf, even when government attorneys decline to intervene. Although these types of cases account for less than two percent of such FCA cases, the cost for defending the cases, especially for rural providers with small operating margins, may be very high.

Since whistleblowers can pursue such cases without government intervention, it undermines the policy of the Department of Justice (DOJ), which directs officials to take into account community access to care in pursuing FCA cases against rural providers. The article highlights the liability risk which rural providers face under the FCA and argues for amending the FCA to allow a whistleblower claim to proceed against providers serving designated underserved areas only where government authorities intervene in the case.

A qui tam suit is one where a whistleblower files suit against a person or company, who is believed to be in violation of a government regulation, when there is a statute which provides for a penalty for such violations.

Health-Matrix: Journal of Law and Medicine publishes legal scholarship that looks at the convergence of law, ethics, medicine, and policy. Health-Matrix is a journal at Case Western Reserve University School of Law, which this year was ranked as having the fifth best health care law program in the world by a U.S. News and World report.