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Private FCA Actions: Practical Implications For Health Care Providers

BY Neil T. Edwards
September 02, 2014

The increase in the number of patients participating in government programs creates opportunities and challenges for health care providers and long-term care facilities, and as the number of such patients swells, it is essential that health care providers remain vigilant in order to avoid potential pitfalls inherent in dealing with these programs. Two important examples of this are federal and state “false-claims” acts.

Increased Regulatory Interest

In the coming years, the population of people eligible for Medicare is expected to grow exponentially, with the baby boomer generation living longer than people of past generations. The Center for Medicaid and Medicare Services (CMS) projects that the Medicare-eligible population (age 65 and over) will reach 54.7 million in 2020, up from 40.4 million in 2010 and 37 million in 2006. Center for Medicare & Medicaid Services, National Health Expenditure Projections 2012-2022, Table 1: National Health Expenditures and Selected Economic Indicators, Levels and Annual Percent Change: Calendar Years 2006-2022. (Available at http://go.cms.gov/1r5gvuR.) In addition, there is the potential for the Medicaid population to grow due to the Affordable Care Act (ACA) expansions, as well as other social and economic factors such as high unemployment and stagnant wage growth. Thus, there is an undeniable upward trend projected for both the Medicare and Medicaid-eligible population.

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