Bloomberg Law
Oct. 25, 2018, 12:01 PM

Shifting Medicare Model Could Set Fraud Traps for Providers

Matt Phifer
Matt Phifer
Health Care Law and Business Reporter

Health-care providers could face new False Claims Act hurdles as the Medicare agency continues to move toward reimbursement based on quality care rather than quantity.

It’s an emerging question whether courts will treat failures to comply with requirements for value-based care programs as fraud. The FCA typically is used to go after health-care providers who billed government funded health programs for treatments that were not provided or were upcoded in the current fee-for-service system that pays for quantity of care.

Now, health-care providers will need to make sure they’re complying with all the requirements of participation in value-based programs, as ...

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