A case coming before the Supreme Court of the United States holds in the balance whether lawsuits and heavy fines can be brought indefinitely against physicians who provide services under Medicare and other federal health care programs.
In KBR v. United States of America Ex Relator Benjamin Carter, petitioners are seeking to overturn earlier court decisions that would eliminate the existing six-year limit on pursuing “false claims” under the federal False Claims Act and would allow repeat lawsuits to be filed.
The AMA filed a friend-of-the-court brief alongside four other organizations, calling on the U.S. Supreme Court to consider the ramifications of earlier court rulings on the matter.
“If affirmed, the combined effect of these rulings will invite private plaintiffs and the government to pursue indefinitely and repeatedly any claim involving alleged fraud against the government,” the brief states. “This elimination of all repose is not only contrary to law but would impose significant burdens on businesses, hospitals and other health care providers.”
The brief points out that physicians could be “forced to defend against stale, repetitive and frequently meritless claims.” This task would require significant costs in maintaining records for an indefinite period, planning for unknown contingencies and defending against inappropriate suits.
For physicians who don’t have sufficient documentation to mount a proper defense or who otherwise decide to settle, the financial damages are considerable.
Under the federal False Claims Act, the penalty for each claim is between $5,000 and $10,000, adjusted for inflation, plus three times the amount of damages “sustained by the federal government.” If information was misrepresented on multiple Medicare claims, for instance, penalties would apply to each claim—regardless of how small the billed amount was.
The case is expected to be argued this winter.
The AMA long has expressed concern over ambiguities in the False Claims Act, a Civil War-era statute being used to raise inappropriate claims, and previously has filed several court briefs reflecting concerns over this law.
