David Pivnick

It was more intended to do things like billing for services not rendered or intentional upcoding, billing for treating dead people versus you know, any allegation of regulatory non-compliance can lead to potential liability under the False Claims Act with this heavy statutory penalty scheme, so long as the non-compliance is purportedly material.

So there's a lot of ability for folks to pursue non-fraudulent, at least, you know, as you or I or our listeners would contemplate fraud, conduct that doesn't really fit in that rubric, but can fit under the act. And in healthcare,

So there's a lot of ability for folks to pursue non-fraudulent, at least, you know, as you or I or our listeners would contemplate fraud, conduct that doesn't really fit in that rubric, but can fit under the act. And in healthcare,

So there's a lot of ability for folks to pursue non-fraudulent, at least, you know, as you or I or our listeners would contemplate fraud, conduct that doesn't really fit in that rubric, but can fit under the act. And in healthcare,

you know, where the statutory penalties right now are, you know, into the five digits per claim, you know, you could be looking at a situation where you build improperly for an E&M code If you got paid $150, give or take, for the evaluation management service, but your liability, if you fraudulently build that code, could be $25,000, it's somewhat outsized and nonsensical, frankly, in proportion.

you know, where the statutory penalties right now are, you know, into the five digits per claim, you know, you could be looking at a situation where you build improperly for an E&M code If you got paid $150, give or take, for the evaluation management service, but your liability, if you fraudulently build that code, could be $25,000, it's somewhat outsized and nonsensical, frankly, in proportion.

you know, where the statutory penalties right now are, you know, into the five digits per claim, you know, you could be looking at a situation where you build improperly for an E&M code If you got paid $150, give or take, for the evaluation management service, but your liability, if you fraudulently build that code, could be $25,000, it's somewhat outsized and nonsensical, frankly, in proportion.

I think there's already some practical and policy issues with the statute, which is not can't amount to me saying fraud is fine, don't worry about it. It's more saying there are appropriate ways to monitor it. And there's a big difference between fraud and regulatory noncompliance getting lumped in with fraud.

I think there's already some practical and policy issues with the statute, which is not can't amount to me saying fraud is fine, don't worry about it. It's more saying there are appropriate ways to monitor it. And there's a big difference between fraud and regulatory noncompliance getting lumped in with fraud.

I think there's already some practical and policy issues with the statute, which is not can't amount to me saying fraud is fine, don't worry about it. It's more saying there are appropriate ways to monitor it. And there's a big difference between fraud and regulatory noncompliance getting lumped in with fraud.

And so taking that framework and then applying the fact that, you know, with some limited exceptions, anyone can bring these claims on behalf of the government. I do think the constitutionality concerns are well taken.

And so taking that framework and then applying the fact that, you know, with some limited exceptions, anyone can bring these claims on behalf of the government. I do think the constitutionality concerns are well taken.

And so taking that framework and then applying the fact that, you know, with some limited exceptions, anyone can bring these claims on behalf of the government. I do think the constitutionality concerns are well taken.

I think if it was fair to be non-constitutional, the way it would practically work would be whistleblowers wouldn't be able to prosecute the claims. So it might not prevent whistleblowers from asserting claims, but it would certainly leave claims where the government declined to intervene and take over the prosecution in a situation where those claims would become

I think if it was fair to be non-constitutional, the way it would practically work would be whistleblowers wouldn't be able to prosecute the claims. So it might not prevent whistleblowers from asserting claims, but it would certainly leave claims where the government declined to intervene and take over the prosecution in a situation where those claims would become

I think if it was fair to be non-constitutional, the way it would practically work would be whistleblowers wouldn't be able to prosecute the claims. So it might not prevent whistleblowers from asserting claims, but it would certainly leave claims where the government declined to intervene and take over the prosecution in a situation where those claims would become

unconstitutional and therefore barred and subject to judgment or dismissal.

unconstitutional and therefore barred and subject to judgment or dismissal.

unconstitutional and therefore barred and subject to judgment or dismissal.

Yeah, so you're right on with the numbers. In any given year, it's in that 20% to 25% ballpark that the government intervenes. Now, it isn't necessarily the case that that the remainder would all go out if it was fair and unconstitutional, because part of what might happen is, you know, it's possible DOJ would intervene more frequently. There might be other steps that were taken to protect cases.