I believe that the author of this piece makes some very valid points, however, I do not completely agree with the statement that providers should have actual knowledge before an overpayment can be "identified". The author states that overpayments should not be "identified" unless the provider has actual knowledge of BOTHtheir existence and the amount (Golden, 2017). In my opinion, simply having the knowledge that overpayments exist is enough to consider it "identified". In the case of the Healthfirst hospitals, they had knowledge of overpayments and what the amount possibly was. Their response was to fire the person that sent the report and pay back a minor amount compared to what was identified as possible. If the author's system was in place, they would incur minimal penalties, if any, simply because they didn't know the actual existence or the amount. Their behavior and response to having knowledge that there was a possible overpayment is something I think the government would see a lot of if this system was in place. The author speaks of the "ostrich effect". I think this is something that would happen often if this bright-line rule were in place.

I agree that in many cases the monetary penalties for things that were not blatantly fraudulent behavior are way too steep. Mr. Golden states that not all overpayments are created equally, and I agree. He also makes a very valid point stating that if the Act's only goal were to make the government whole again, the large punitive damages and monetary penalties would be unnecessary (Golden, 2017). However, his arguments were not persuasive in making me agree with his thoughts on what should and shouldn't be considered "identified".

AGREE OR DISAGREE? DEBATE:

https://openscholarship.wustl.edu/law_lawreview/vol94/iss5/8/

Answer rating: 100% (QA)

I disagree with the authors argument that healthcare providers should have actual knowledge of overpayments before they can be considered identified W... View the full answer