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Health Law and Policy Commons

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Medicaid

Washington University Law Review

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Full-Text Articles in Health Law and Policy

Wrongly “Identified”: Why An Actual Knowledge Standard Should Govern Health Care Providers’ False Claims Act Obligations To Report And Return Medicare And Medicaid Overpayments, Nicholas J. Goldin Jan 2017

Wrongly “Identified”: Why An Actual Knowledge Standard Should Govern Health Care Providers’ False Claims Act Obligations To Report And Return Medicare And Medicaid Overpayments, Nicholas J. Goldin

Washington University Law Review

In 2015, Medicare spent $632 billion on health care for America’s elderly (and other covered groups). Medicaid spent another $554 billion to provide health care to America’s needy. The government estimates that improper payments account for as much as 10% of Medicare and Medicaid spending. Given the vast amount of money at stake, and the fact that there is bipartisan support for recovering taxpayer dollars, it is no surprise the federal government has made it a priority to recoup the money lost to health care fraud each year. The results are noticeable: annual recoveries for health care fraud ...


Mission And Markets In Health Care: Protecting Essential Community Providers For The Poor, John V. Jacobi Jan 1997

Mission And Markets In Health Care: Protecting Essential Community Providers For The Poor, John V. Jacobi

Washington University Law Review

Should government protect mission-driven providers in the shift to Medicaid managed care? In part, the answer to this question turns on the statutory purposes of Medicaid as both a vehicle for providing an opportunity for the poor to enter the medical mainstream, and as a program to provide medical care in a setting that includes a wide variety of culturally appropriate social services. The answer also turns in part on an economic and public policy analysis of the performance of these mission-driven providers in comparison with their for-profit counterparts. Part I of this article will describe the complex mission of ...