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Prof. Hall Examines Health Care Fraud in National Forum

JULY 19, 2011—On July 12, 2011, Professor Ralph F. Hall joined a panel of experts on Capitol Hill to discuss legal policies and the effectiveness of the laws passed to counter health care fraud. The forum, "Health Care Fraud and Abuse Enforcement: What’s at Stake?," focused primarily on the pharmaceutical sector.

Hall teaches health law and food and drug law and writes frequently on the False Claims Act, Food and Drug Administration regulations, and related topics.

Among additional panelists were Christopher Wray, former assistant attorney general for the Department of Justice (DOJ) Criminal Division, now a partner at King & Spalding; John J. Pease, Assistant U.S. Attorney and chief of health care fraud in the U.S. Attorney’s Office of the Eastern District of Pennsylvania; Laurence Freedman, former assistant director and trial attorney in the DOJ Civil Fraud Section, now a partner at Patton Boggs; Matthew Hay, publisher of the newsletter Rx Compliance Report, and Nielsen Hobbs, editor of the prescription drug industry newsletter, the Pink Sheet.

In a July 14 article in Main Justice, panelists agreed that the number of cases of health care fraud and abuse being prosecuted and the costs of settlements are on the rise. What is unclear is whether the increases reflect the difficulty in complying with the complex laws or greater efforts and resources toward enforcement.

Freedman noted that expansion of the False Claims Act has led to pressure on government investigators to seek high settlements rather than help companies that are trying to follow the laws understand their requirements. Wray agreed that enforcement has increased and now tackles more subtle incidents, where fraud is less clear. A particularly intimidating enforcement tool, Wray noted, is the Department of Health and Human Services Inspector General’s power to bar companies that have committed fraud from doing business with the government.

Hall said that just the "threat of the threat" of debarment has inhibited many public companies from challenging fraud allegations in court. "If you’re a publicly traded company and you are excluded from participation in health care programs, that is essentially the death penalty," Hall said, explaining that stockholders are likely to lose confidence in a company when they learn that the government may be pursuing exclusion.

The forum was the first in a series of three. The second, on October 18, will focus on new legal theories and other trends influencing enforcement. The third, on November 15, will feature strategies for cooperation between government and industry to foster compliance with the laws.

The series is sponsored by King & Spalding and by Main Justice, an independent online news organization that covers the inner workings of the DOJ.


Ralph Hall

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