The false claims act and the eroding scienter in healthcare fraud litigation

This article addresses the federal government's expansive methods in tackling healthcare fraud, particularly in misapplying the False Claims Act. Although tasked with the obligation to curtail the fraudulent submission of Medicare & Medicaid claims, the U.S. government must rein in the current trend to utilize the False Claims Act against smaller medical providers. As the Act's original focus has ebbed in significance, the government has increasingly applied the False Claims Act to circumstances that do not evince actual fraud. In doing so, federal courts have effectively eroded the statute's critical scienter requirement. The federal common-law doctrines of "payment by mistake" and "unjust enrichment" adequately address the payment of non-fraudulent, albeit false, Medicare & Medicaid claims. Yet the federal government pursues these appropriate remedies only rarely and in the alternative, essentially when the government fails under the False Claims Act. Thus, this article argues for reform, calling for a clearer delineation between remedial and punitive measures. In cases involving smaller medical providers, courts should strictly limit the False Claims Act to those instances where fraud is clearly manifest.     

Healthcare fraud and quality of care: a patient-centered approach

This Article explores the intersection between quality of care and healthcare fraud by examining the extent to which quality-related fraud settlements benefit patients. The author argues that, although the protection of beneficiary health and welfare often is invoked by the federal government as one of the reasons for undertaking anti-fraud efforts, such considerations do not appear to play a large role in many of the settlements that are negotiated. While returning funds to the federal Treasury helps to ensure that the federal healthcare programs remain solvent and continue to serve beneficiaries in the aggregate, it may not adequately address harm to individual patients. Thus, the author concludes it may be time to explore new models of fraud settlements that can provide adequate compensation to the patients who may have suffered harm.     

Section 525(a) of the bankruptcy code plainly does not apply to Medicare provider agreements

Section 525(a) of the Bankruptcy Code prevents government entities from discriminating against debtors based on the debtor's bankruptcy filing. This Article analyzes how this provision is applied to healthcare providers who file for bankruptcy. Some commentators have expressed concerns that because of Section 525, the federal government is unable to deny a bankrupt provider a new Medicare provider agreement due to the debtor's failure to pay debts discharged during bankruptcy. This Article, however, argues that Section 525 does not apply to a provider agreements because it is not a "license, permit, charter, franchise, or other similar grant" as defined by the statute. Therefore, the author concludes that debtor healthcare providers should not be allowed back into the Medicare program without first paying their statutorily required debts.     

Negotiating Citizenship on the Frontlines: How the Devolution of Canadian Immigration Policy Shapes Service Delivery to Women Fleeing Abuse

This article examines how nongovernmental service providers navigate devolutionary trends in Canada, in both immigration control and integration policy, when responding to migrants who come to them for help and support. Drawing upon conceptualizations of citizenship as a “negotiated relationship” ( Stasiulis and Bakan 2003 ), I explore how social service providers, who work amidst a complex interplay of federal, provincial, and local policies, can influence both who is deemed worthy of social membership and what rights an individual can successfully claim from the state. Empirically, this article focuses on observation of community meetings and conversational interviews with service providers in violence against women shelters in Toronto, Ontario, Canada's most populous and diverse city. While service providers navigate different levels of government to advocate for women's rights to seek safety from abuse, I argue that both individual service providers and the organizations in which they work monitor and constrain the degree to which they openly challenge state authority to restrict immigrants' “right to have rights” ( Arendt 1951 [1979] , 296).     

The failure of community benefit

Though proponents of tax exemption for health care providers continue to extol the virtues of the community-benefit test, Part II of this article illustrates that the train pretty much has already left the station on this front. Both the federal government and the states increasingly look to uncompensated care as the touchstone of exemption for health care providers. To a great extent, this transition back to a "relief of the poor" standard for exemption is the result of the inherent lack of precision in community benefit standards, along with the general trend of empirical evidence that nonprofit health care providers behave similarly to their for-profit counterparts. Faced with this situation, federal and state policymakers naturally have focused on charity care as the one quantifiable behavioral difference to justify exemption. Nevertheless, some empirical evidence suggests that nonprofits may engage in socially desirable behavior other than simply free care for the poor, and the arguments that a mixed ownership system provides the best overall health care model cannot be dismissed out of hand. Thus, despite my past criticisms of the community benefit formulation, I have come to the view that we should seriously consider the options available beyond complete repeal of the community benefit test or a return to a strict charity-care exemption standard. I continue to believe that we should demand a fairly high level of "accountability" from exemption, however, and that exemption should have some direct causal connection to whatever socially-desirable behavior we are seeking. While one option along these lines is to adopt Nina Crimm's approach of rewarding specific behaviors through a deduction or credit system, using "enhancing access" as a test of exemption may provide the best combination of flexibility and verifiable behavioral differences to support continued exemption for health care providers.     

International mutual legal assistance in criminal law made redundant: A comment on the Belgian Yahoo! case

This article offers a critical examination of the court judgements in a recent Belgian case against Yahoo!. It examines the challenges related to the establishment of jurisdiction for Internet-based services and the role that procedures of mutual legal assistance should play. Belgian law obliges providers of “electronic communications services/electronic communications networks” to cooperate with Belgian law-enforcement authorities and to handle over communication and personal data. Although the terms are derived from the EU Electronic Communications Regulatory Framework, a much broader interpretation to them was finally given by the Belgian Supreme Court. Seemingly this implies that, from now on, a US-based company such as Yahoo! is, at least under Belgian law, under a legal obligation to directly comply with an order issued by Belgian law-enforcement authorities.     

Coexistence, conflict, and cooperation: public policies toward medical devices

Medical devices include thousands of products, many of which have greatly contributed to the quality of health care. As devices have proliferated, so have public policies that affect them. The federal government intervened to promote three fundamental values: safety by federal regulation, innovation through federal funding of research and development, and access by providing services under Medicare. The policies generally coexisted without conflict. However, two recent developments--the advent of cost containment and the expansion of the tort liability system--present a potentially disruptive influence on these policies, and threaten to undermine the values they serve. Because cost restraints are inevitable and the tort system provides consumer protection, the challenge for policymakers is to reconcile them with the values of safety, innovation, and access. The proposals presented here seek to promote coordination to protect those values without imposing unacceptable costs on the health care system.     

Flemish immigration in wallonia and in france:

Flemish emigration during the nineteenth and twentieth centuries is too complex to be dealt with definitively in a single article. Our main objective is to provide an overview of the migration towards France and Wallonia by looking at its chronology, and the spatial distribution of emigrants and their descendants. In this effort, patronym distribution is very helpful. As markers of migratory movements, patronyms from a collection of nominative lists give us a handle on migration flows as no other evidence can. Comparing France and Wallonia, the two destination areas, it is possible to see similarities between types of migrants: workers in heavy industry, workers in the agricultural sector, and workers engaged in domestic services. In addition, three phases may be identified in the arrival of a Flemish population in France and Wallonia: an emigration phase, an integration phase, and a redistribution phase. The last phase is also part of the urbanization process and is linked with upward social mobility.     

Adoptions Gone Awry: Enhancing Adoption Outcomes Through Postadoption Services and Federal and State Laws Imposing Criminal Sanctions for Private Internet Rehoming

The federal government should invest in adopted children who make up the future of the country and are in dire need of rehabilitation and therapy because of their past circumstances. If the government steps in to rescue vulnerable children from inadequate or abusive birth parents by removal, it should also intervene when adopted families are faced with behavioral problems of adopted children that the adopted parents cannot address on their own. Postadoption services need to be accessible and effective to ensure the success of adopted families. Assisting families in crisis postadoption will lower the instances of dissolution and rehoming and keep adoptive families intact. In cases in which postadoption services fail, uniform federal legislation is necessary to make it a federal crime to advertise children for adoption on the Internet without proper certification and state legislation is required to make it a crime to pass on adopted children to strangers without judicial consent, to dissuade Internet rehoming. Internet rehoming of adopted children should be a serious crime as it is tantamount to child trafficking.© 2014 Association of Family and Conciliation Courts

Key Points for the Family Court Community:
• Postadoption services need to be more accessible and more narrowly tailored to the needs of adoptive families to ensure the success of adoptions.
• Better postadoption services create better adoptive families and adoptive parents will not reach the point of dissolution or private Internet rehoming.
• Adoptive parents should be provided with information regarding all available postadoption resources after adoption is finalized and a government Web site should be created that lists all available resources.
• The federal government needs to provide funding to states that specifically target postadoption services.
• A uniform federal statute is required to punish parties who use Internet forums to avoid government oversight and privately rehome their adopted children.
• States should enact laws that criminalize the unauthorized interstate placements of children.

     

Flemish immigration in wallonia and in france:: Patronyms as Data

Flemish emigration during the nineteenth and twentieth centuries is too complex to be dealt with definitively in a single article. Our main objective is to provide an overview of the migration towards France and Wallonia by looking at its chronology, and the spatial distribution of emigrants and their descendants. In this effort, patronym distribution is very helpful. As markers of migratory movements, patronyms from a collection of nominative lists give us a handle on migration flows as no other evidence can. Comparing France and Wallonia, the two destination areas, it is possible to see similarities between types of migrants: workers in heavy industry, workers in the agricultural sector, and workers engaged in domestic services. In addition, three phases may be identified in the arrival of a Flemish population in France and Wallonia: an emigration phase, an integration phase, and a redistribution phase. The last phase is also part of the urbanization process and is linked with upward social mobility.     

Regulatory Science and the Data Quality Act

The importance of data quality was highlighted in an amendment attached to a 2000 law enacted by the 106th U.S. Congress. The law known as the “Data Quality Act” or the “Information Quality Act,” mandated that the Office of Management and Budget (OMB) issue guidance to federal agencies for “ensuring and maximizing the quality, objectivity, utilility, and integrity of information (including statistical information) disseminated by federal agencies.” In turn, OMB required more than 90 federal agencies such as the United States Environmental Protection Agency (EPA) to implement data quality guidelines. These guidelines have created a rigorous, if not rancorous, debate within the regulated community. This paper will provide a brief synopsis of the evolution of the Act, discuss how the Act and scientific uncertainty interrelate, and review the status of the Act's petition process for correcting government disseminated information.     

Applying antitrust law to nonprofit healthcare entities: arguments for a greater attention to detail

This Article begins with an antitrust primer, then analyzes the appropriate application of antitrust principles to nonprofit healthcare providers. In light of the inherent charitable character of nonprofit healthcare providers, the author contends that the government and the courts should accord some deference to nonprofit hospitals when they are seeking approval of mergers. To date, this has not generally been the case, although a few recent court decisions have rested their approval of mergers, in part, upon the nonprofit character of the merging entities. The author, in particular, believes the paradigmatic local nonprofit hospital with a community board is less likely than a for-profit hospital to abuse any market power that it may obtain through a merger; consequently, any such merger should not be analyzed solely under the traditional presumptions of antitrust jurisprudence. Rather, the premerger analysis should involve meaningful consideration of the hospital's charitable character.     

Violence risk profile of medium- and high-security NGRI offenders in Belgium

Under Belgian law, offenders not guilty by reason of insanity (NGRI) are committed by the courts to forensic mental health treatment. The use of violence risk assessment tools has become routine in these settings. However, there are no national statistics regarding violence risk assessment in the Belgian forensic population. A study was undertaken to collect risk assessment data (PCL-R, VRAG, HCR-20) on a large cohort of forensic patients committed to Medium Security units in the Flanders region and in High-Security units in the Walloon region. Flemish patients were expected to present a lower risk compared with their Walloon counterparts. Instead, data yielded by a structured risk assessment method demonstrate the opposite. Moreover, the majority of patients in Flemish facilities had committed violent offenses and were institutionalized for shorter periods whereas the majority of Walloon patients had committed sexual offenses and were institutionalized for markedly longer periods.     

The USPS as an OSP: A Remedy for Users’ Online Privacy Concerns

New digital technologies, and a legal system that has failed to keep pace, are allowing government and the private sector to engage in unparalleled unauthorized surveillance of online personal data contained in emails and in the aggregation of users’ online searches. This article argues that the U.S. Postal Service — compelled to protect communications privacy by its enabling statute, the Fourth Amendment, and other federal laws — should provide email and browser-search engine services to shield users from unauthorized online behavioral marketing and tracking by the private sector and metadata collection by government, and, just as important, give users legal remedies against such abuses. To that end, this article provides a legal analysis and rationale to support the USPS's authority to offer such nontraditional postal services.     

Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights

In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family planning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.     

Free movement of patients: Directive 2011/24 on the application of patients' rights in cross-border healthcare

This contribution comments on Directive 2011/24, providing a legal framework for cross border healthcare 13 years after the famous Kohll and Decker case law. The Directive contains provisions concerning the reimbursement of costs, the responsibilities of the Member States and their mutual cooperation in healthcare. Analysing the (potential) impact of the Directive 2011/24 on EU healthcare systems, patients and healthcare providers, it becomes clear that the impact of the Directives reaches far beyond patient mobility. The Directive creates patients' rights, pays attention to the quality and safety of healthcare services and creates an excessive structure of cooperation in the field of healthcare. The European Union seems ready to use its economies of scale to improve healthcare for all European patients.     

From shared cost to block funding and beyond: the politics of health insurance in Canada

This paper takes as its starting point recent major changes in arrangements between the federal and provincial government in Canada concerning the sharing of costs for health insurance programs. The switch from a shared cost (conditional grant) to a modified block funding system was motivated by federal desires to limit and make predictable their expenditures, by provincial desires to increase the flexibility of their allocation of funds and by a mutual desire to limit any growth of health care costs as a proportion of GNP. Concerns related directly to improving medical care delivery were insignificant The changes will effectively centralize responsibility for program financing and program delivery, thus providing a powerful incentive for provincial governments to apply very strong measures to control costs. For reasons largely external to the relationship between public sector insurers and the suppliers of medical services, these attempts are unlikely to be successful in the short run. The probable impact of this difficulty on government and members of the health care delivery system is assessed.     

The Swedish mental health system. Past, present, and future

In sum, the evolution, strengths, and weaknesses of the Swedish mental health system are quite similar to mental health systems in other Western countries; early reliance on stand-alone, state psychiatric hospitals, followed by deinstitutionalization and development of largely ambulatory, community mental health care. This evolution has been complicated in Sweden by the multiple levels and system components, the state, the county councils and the municipalities. Unlike the United States, but similar to Britain, community mental health care in Sweden is provided by two systems; treatment (and forensic services) by the county councils' mental health providers, and generic services by the municipalities' social welfare system. The resulting division of roles and responsibilities creates a strong need for collaboration and coordination of activities on behalf of consumers. It can also have the unintended disincentives to serving more difficult consumers. All these difficulties not withstanding, the Swedish mental health system has made major stride in providing quality, appropriate care.     

Attorney views on the use of private agencies for probation supervision and treatment

The exponential rise in probation caseloads has necessitated that some jurisdictions contract with private probation agencies and community-based private treatment providers. Regulations that monitor private providers are ill defined or absent, leaving standards open to broad interpretation. Attorneys in one jurisdiction that used private providers were surveyed to measure their beliefs about private treatment providers for people sentenced to probation. The research found that attorneys supported private provider representatives being present in court to contact defendants and to provide evidence to strengthen probation violations. Private agency reputation and standardized criteria were important to establish qualifications in offering supervision and treatment services.