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Litigation Services Handbook, 2015 Cumulative Supplement: The Role of the Financial Expert, 5th Edition by Daniel G. Lentz, Roman L. Weil

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CHAPTER 37A

HEALTH CARE FRAUD AND FALSE CLAIMS ACT DAMAGES

Frank E. Correll Jr. Thomas A. Gregory Gregory M. Luce Karen Makara

37A.1 INTRODUCTION

In 2012, health care expenditures represented approximately 17.2 percent of the U.S. gross domestic product.1 Health care fraud represents a significant cost to the U.S. government and to taxpayers. A 2012 article in the Journal of the American Medical Association—coauthored by a former administrator of the Centers for Medicare and Medicaid Services (CMS), the federal agency charged with implementing the Medicare and Medicaid programs—estimated that health care fraud cost those two programs between $30 billion and $98 billion annually.2 The False Claims Act (FCA) is the government’s primary and most effective civil enforcement tool in fighting health care fraud. It ...

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