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16 Ind. Health L. Rev. 1 (2018-2019)

handle is hein.journals/inhealr16 and id is 1 raw text is: 








    Indiana Health Law Review

Volume  XVI                         2018                          Number   1



                            ARTICLES



    THE   FALSE CLAIMS ACT AND THE ESCOBAR DECISION:
               WHAT IS ON THE HORIZON FOR THE
                       HEALTHCARE INDUSTRY



                           NATASHA  BOYADZEVA*



                              I. INTRODUCTION

    The  federally funded Medicare  and  Medicaid  health care programs   are
subject to fraud and abuse by various health care entities due to the opportunity
for the entities to receive a great payout. The payout has been expanding over the
years and is projected to grow, making the health care system an attractive target
for fraud and abuse.' The False Claims  Act  (FCA)  is the primary tool for
combating  such  fraud and  abuse.2 In effect, FCA provides  remedies to  the
Government   and  individuals, including consumers and taxpayers.3 The  FCA
statute enables the Federal Government to recover billions of dollars that are lost
due to fraudulent activities. In the Fiscal Year 2017, the Government recovered



      * Natasha Boyadzieva is an attorney practicing in California. Ms. Boyadzieva graduated
in 2017 with her J.D. with honors degree from The George Washington University Law School.
She would like to thank her family, friends, and the editors of the Indiana Health Law Review for
their support and guidance.
     1. National Health Expenditure Data Fact Sheet, CTRS. FOR MEDICARE & MEDICAID
SERVS., https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-
reports/nationalhealthexpenddata/nhe-fact-sheet.html [http://perma.cc/76JQ-YFHV] (last modified
Apr. 17, 2018); see also Health Care, Projectionsfor Major Health Care Programs for FY 2018,
CONG.  BUDGET  OFF., https://www.cbo.gov/topics/health-care [http://perma.cc/373P-7BWA];
Juliette Cubanski & Tricia Neuman, The Facts on Medicare Spending and Financing, KAISER FAM.
FOUND. (June 22, 2018), http://kff.org/medicare/fact-sheet/medicare-spending-and-fmancing-fact-
sheet/ [http://perma.cc/T59P-MQLC].
     2. False Claims Act (FCA), 31 U.S.C. §§ 3729-33 (2012). Besides civil FCA provisions,
there are also criminal ones (18 U.S.C. §287 (2012)) that are not the focus of this Article.
Additionally, twenty-nine States and D.C. have enacted their own civil FCA provisions similar to
the federal FCA. See, e.g., LA. STAT. ANN. §438.3 (2018).
     3. See generally TAXPAYERS AGAINST FRAUD, www.taf.org [https://perma.cc/7SEH-
M8QL]; The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers
by Combating Health Care Fraud, CTRS. FOR MEDICARE & MEDICAID SERVS. (Jan. 18, 2017),
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-
01-18-2.html [https://perma.cc/QXP3-4WZZ].

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