Fraud refers to a criminal deception with the aim of achieving financial gains from the victim. In the context of the Olympus Corp of America case, US largest distributor of endoscopes and other medical equipment, it committed fraud by giving doctors and healthcare institutions kickback which include, lavish meals, foreign travel, free endoscopes, and millions of dollars in grants in order to sell their medical equipment to the institutions. Abuse, on the other hand, is to misuse something, like an office or position, for a bad purpose. Olympic Corp. of America was abusive in that they used their influence to unduly win tenders which eventually put the entire healthcare at risk by influencing the judgment of a provider concerning the health of a patient thus resulting in the inappropriate pricing of medical apparatus.
The primary role of Healthcare Fraud Prevention and Enforcement Action Team is to prevent fraud, waste, and abuse in the Medicare programs so as to strengthen the healthcare system. In the OCA case, the HEAT task force played a role in the investigation of the incidents in which OCA was adversely mentioned to have anticipated unethically in one way or another.
The False Claim Act, otherwise referred to as Lincoln law, is a federal law which levies liabilities on persons and federal contractors who swindle the government in its healthcare programs It is the fundamental litigation with which the federal government combats swindle against an individual or a company. This law is inclusive of a qui tam provision which essentially provides for persons, known as relators, with no affiliation with the government, to initiate litigation on behalf of the government. Such persona is called whistleblowers especially in if it happens that they are also employees of the same organization they are filing actions against. Individuals filing under this act usually receive a percentage of the recovered damages, usually 15-20%.
The federal statute is a criminal statute which forbids the offer to exchange, or the actual exchange itself, of any valuable thing with the aim of inducing or rewarding the referral of any healthcare program run by the federal government (Attorney Urges Healthcare Providers to Stay Informed about Anti-Kickback Laws, 2009). The statute is comprehensively drafted and institutes fines and penalties for both parties involved in the illegal deal. A conviction for a single desecration under the statute often leads to a penalty of not more than $25,000 as well as a jail term of up to five years. Moreover, conviction automatically leads to compulsory prohibition from participation in any transaction with the federal healthcare program. Without conviction, persons who go against the statute are still likely to be prohibited from federal healthcare programs by the secretary of health and human services whenever they deem necessary. Moreover, the government may assess' civil money fines. These civil money penalties could lead to treble damages and an additional 50,000 for every instance of defilement of the statute. Even though the statute does not give an individual a private right of action, there is a channel availed by the false claims act in which persons can initiate qui tam actions alleging a defilement of the statue.
Attorney Urges Healthcare Providers to Stay Informed about Anti-Kickback Laws. (2009). Community Oncology, 1(1), 53-56. Doi:10.1016/s15485315(11)70777-x.
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