Qui tam claims: threat to voluntary compliance programs in health care organizations

The Department of Justice (DOJ) reports that after violent crime, health care fraud is the department's top priority. The number of health care fraud investigations pending at the DOJ increased from 270 cases in 1992 to more than 4,000 in 1997. The DOJ's primary weapon in prosecuting health care fraud is the federal False Claims Act (FCA) of 1863 (31 U.S.C. secs. 3729-3733). Almost unique among federal antifraud provisions, the FCA may also be used by "private prosecutors" to file lawsuits on behalf of the federal government charging organizations with submitting false claims to the government. The FCA rewards such whistle-blowers with a share of any resulting recoveries as a bounty and protects them from discharge for filing false claims lawsuits against their employers. It also requires defendants to pay the costs and attorneys fees of successful claimants. Although the private "bounty hunter" features of the FCA data back to the Civil War, these so-called qui tam claims were nearly dormant until 1986, when Congress amended the FCA to revive their use. Following the 1986 amendments, and paralleling the rapid increase in federal reimbursements for health care costs, private qui tam claims have far expanded beyond their traditional purview of defense contracts into the field of health care. By 1997, health care providers were the targets of 54 percent of the 530 private qui tam lawsuits field that year.     

The brave new world of Medicare and Medicaid fraud and abuse enforcement: whistle-blowers, pre-filing agreements, and voluntary disclosure

Providers participating in the recent wave of mergers, acquisitions, and affiliations may have unwittingly expanded their false claims exposure because many false claim-type situations are difficult, if not impossible, to identify in pre-closing due diligence. In addition, the possibility of retrospective characterization of ordinary billing mistakes as "false claims" increasingly introduces significant uncertainty to the average provider's financial future. To date, the single most effective approach to this problem is an independent compliance review to identify and resolve any existing exposure, including voluntary disclosure if appropriate, and an ongoing compliance program to communicate to all employees not only the content of applicable rules but also the genuine commitment of management to ensure continuing compliance above other concerns.     

Dangerous work and name disclosure

Name disclosure improves service quality as well as the supervision and management of employees. When such disclosure has the possibility to endanger employees, however, a conflict arises between the need for public disclosure and the maintenance of work safety. To improve the discipline and responsibility of police officers, the Taiwanese government is planning a new policy of sewing names on officers’ uniforms. To determine the impact, this study assumed implementation of the policy and investigated police officers’ perceptions of and reactions to it. Respondents included 337 front-line officers whose main duties were related to law enforcement or other services that involve direct contact with the public. The results showed that police officers interpreted the policy as a disclosure of personal information, that their perception of future revenge risk potential, work stress, and attention to amicable attitudes toward the public were significantly higher, and that their intrinsic work motivation was significantly lower. There was no significant difference, however, in terms of police officers’ pay satisfaction.     

公司法人财产权与公司治理

从探讨公司法人财产权和公司治理二者关系角度入手,对中国公司法中"法人财产权"的内涵与性质加以阐释和分析。法人财产权是一种综合性的权利,包括对实物财产享有的所有权和对其他财产享有的完整权利,法人财产权的确立与归属是公司治理的基础与保障,是公司治理权力分化与制衡的出发点及归宿,而科学有效的公司治理结构的建构与确立也维系着法人财产权的地位,是实现法人财产权的组织保证。新《公司法》删除了原《公司法》关于公司中的国有资产所有权属于国家的规定,为建立现代意义上的公司制度与科学合理的公司治理结构奠定了基础。     

Compelled disclosure of research data

Voluntary data sharing among psychologists will minimize the need for courts to compel disclosure of research information. A review of recent federal court decisions indicates that disclosure of research data from other disciplines has been compelled by subpoena when the data are relevant to the central issue of the litigation and require independent verification. Voluntary sharing of data among psychologists will minimize the need for compelled disclosure by permitting independent verification of the methodology and findings. Professional organizations can assist by encouraging voluntary data sharing and by serving as neutral intermediaries to minimize disruption when disclosure is compelled.     

Sample patient medical information use and disclosure notice

In accordance with the federal health privacy standards promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), covered entities must provide adequate notice to individuals of their policies and procedures regarding protected health information. The form below may be used as a starting point by covered entities for the development of such notice.     

Corporate Governance and Corporate Social Responsibility in Profit- and in Non-Profit-Organizations

Corporate Governance governs corporations. To discuss the law and economics of corporations, their performance on the market and management control by legislation and government, is to discuss Corporate Governance. Now, Corporate Governance is being challenged by a new concept to conceive the role of corporations in the world and to control their managers: this is the concept of Corporate Social Responsibilty (CSR). This concept focuses on other than merely profit centered functions of corporations; rather, performance of corporations is measured by criteria of good corporate citizenship. In the Non-Profit sector, corporations also play a major role, although organizations in this sector typically differ from business corporations in several aspects. Yet, deficits of transparency and control of NPO are being discussed here as well. The tendency is to draw from the concept of corporate governance to develop appropriate remedies. Furthermore, the discussion of Corporate Social Responsibilty has also made its way to the NPO sector.     

Procedural justice and regulatory compliance

This is a study of perceptions of the procedural justice of a business regulatory process among 341 Australian chief executives of small organizations. Only mixed support is found for the notion that procedural justice perceived by chief executives explains changes in the compliance of the organizations they run. A factor analysis suggests that five facets of procedural justice—consistency, correctability, control, impartiality, and ethicality—can be combined to form a single measure. The decision accuracy facet was not part of the general procedural justice factor. It is just one of these facets, control, that is significantly associated with changing compliance. As the chief executive's perception that they have had some control over the enforcement process increases, organizational compliance improves. The procedural justice measures correlate more strongly with regulatee satisfaction for this regulatory regime than do regulatory outcomes.