Evaluate How the Healthcare Qui Tam Affects Health Care Organizations

Evaluate how the healthcare Qui Tam affects health care organizations

1. Qui Tam is defined by the phrase "he who sues for the king as well as for himself." This is a type of legal case in which the whistle-blower or relator files on behalf of the government. The government can then decide to take over the prosecution or not. If the government chooses not to proceed with the case, the relator may continue alone (Showalter, 2012).

2. In healthcare, sometimes the qui tam plaintiffs argue that a claim involving a kickback or an illegal doctor self-referral is a violation of the False Claims Act (FCA). The case may be legitimate otherwise. One case is the United States ex rel. Marcus v. Hess. In this WWII case the contractor's claims were fraudulent because the contract was secured through collusion. Another case, United States ex. rel. Woodard v. Country View Care Center, Inc. involved defendants who submitted cost reports to Medicare payments to "consultants" that was really kickbacks for referrals. The FCA applied to this case because the defendants' reimbursement was based on these cost reports. In United States v. Kensington Hospital, the case was filed after arguments resulted from the start of the prospective payment system relating to Medicaid reimbursement, government losses, and the cost of kickbacks not making false claims. United States ex rel. Pogue v. American Healthcare, the FCA case was not dismissed due to the violations of the anti-kickback and Stark self-referral laws (Showalter, 2012).