DEBATE: AGREE OR DISAGREE?

"There simply cannot be fraud within the meaning of the FCA when reasonable medical professionals disagree about whether a treatment or procedure is necessary" (Pearlstein & McClane, 2017).

"Federal Claims Act (FCA) holds government contractors, including health care providers civilly liable to the United States for treble damages and penalties if they knowingly or recklessly submit false or fraudulent claims to a government payer, such as Medicare and Medicaid" (Pearlstein & McClane, 2017).

"Medical experts in necessary cases play another important role for the government or a relator, who will try to establish broad geographical "fraud" without having to actually prove that each individual treatment at issue was unnecessary. Imposing the punitive FCA liability in such cases is simply unfair, and bears no relationship to what the FCA was designed to accomplish" (Pearlstein & McClane, 2017).

I agree with the authors that is not fair to file a fraud claim without having to actually prove that the issue was unnecessary. A room full of reasonable medical professionals will have differences of opinion as to what they deem to be medically necessary which truly is "second-guessing" as to what is known to be right.

DEBATE: AGREE OR DISAGREE?