Dealing with Fraud
Joseph B. Amah
Professor Dr. Wanda E. Allen
HSA 515 Law and Health Care System
Delaware County Campus
June 18, 2013
Fraudulent behaviors have deep rooted history in most American organizations, including medical institutions. There is no doubt, therefore, that one of several ways an administrator can succeed as a Chief Nursing Officer (in a facility wrecked by news of abject corruption and empirical fraudulent activities) is being knowledgeable about these historical facts and taking corrective actions. Necessarily, any report of dishonest behaviors such as the one relating to the ...view middle of the document...
Be that as it may, in order to properly delve into this question, understanding Qui Tam and some of its connotations may help in understanding the impact a qui tam claim may have on healthcare organizations. This two-word phrase is a short-hand Latin phrase meaning “he who sues on behalf of the king actually sues on behalf of himself or herself” (Showalter, 2012, p. 439). Incidentally, in a Qui Tai action, an individual or employee in possession of evidence that an institution or another person has committed acts of fraud against the government can file a claim on behalf of the state. Such a person is lawfully entitled to a significant portion of funds recovered from the action. This entitlement for a whistle blower is generously given by government as compensation for the high risks taken by these relators.
Reverting to the impact of Qui Tam on organizations that venture in institutional violation of the False Claim Act (FCA) for the sole purpose of defrauding federal or state government, there are a number of consequences, a few of which are outlined below. Let us consider a case in point here: if a qui tam case is filed against a healthcare organization on grounds that the facility violated the FCA, that institution would possibly face 1) a likely imposition of excessive fines or seizures, 2) possible revocation of company’s license (permit) to operate, 3) possible prison terms for manager & owners and 3) a possible permanent closure of the facility. As mention supra, the intent of health care organization should never be to corrupt or go in violation of governmental regulation. Nonetheless, where this is the case, whistle-blowers, (protected by the False Claim Act) respond by filing a qui tam claim. Presenting a more precise argument about wrong doings at corporate organization, Showalter (2012) laments that if a corporation is used for the purpose of defeating public convenience and justifying fraudulent behaviors simply for self-enrichments, the law will disregard that entity’s corporate status and then directly place liabilities on the owners of the corporation. For a corporate manager, this is critical because not only would a qui tam claim result in a permanent and disgraceful closure of his/her organization, but the action could eventually end up holding a manager of a discontinued entity criminally liable for corruption.
Provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations.
In recent time a number of Qui Tam claims have been filed alleging instances of corrupt institutional practices in many organizations throughout the United States. For the purpose of this pape,r four of these cases will be highlighted beginning with a recent Federal ruling against drug maker Pfizer. In a 1st U.S. Circuit Court of Appeals, a Federal court (for the first time) “upheld a $142 million jury verdict” against the drug maker giant, Pfizer (http://www.lexisnexis.com).The report further reveals that in...