The U.S. health care industry is a fraudster’s paradise. While the vast majority of the players in the industry are focused on saving lives and improving health care for patients, fraudsters use this goodwill to their benefit. The health care industry is also buoyed by significant government funding—be it through Medicare, Medicaid, or the many grant programs designed to support health systems nationwide. Fraudsters manipulate these programs, and the goodwill associated with them, to steal funds from the government to line their pockets.
A major health care industry overhaul occurred in 2010 with the passage of the Patient Protection and Affordable Care Act, otherwise known as just the Affordable Care Act or, colloquially, Obamacare. The bill attempted to help block fraudsters by amending a longstanding Anti-Kickback statute to assure that fraudsters could not use the government funding programs contained in the ACA to further their fraudulent schemes. In the decade since the ACA’s passage, the courts’ interpretation of the Anti-Kickback statute in relation to ACA fraud has become split, with the split most notable between the U.S. Court of Appeals for the Third and the Eighth Circuits. The Third Circuit has adopted a more plaintiff/relator friendly interpretation while the Eighth Circuit has reached the opposite conclusion. Until the U.S. Supreme Court settles the circuit split, choice of venue is key for those bringing claims under the Anti-Kickback statute.