Assessing the Impact of the False Claims Act on Healthcare Delivery

This supplement analyzes the effect of the False Claims Act on health care delivery for Medicare beneficiaries with Alzheimer’s Disease and Related Dementias (ADRD). Patients with ADRD tend to be high users of health and long-term care services, due to the complexity of their medical needs, the prolonged nature of the disease, and the ambiguity that surrounds appropriate treatment. As a result, the treatment of ADRD patients may be particularly prone to fraud and abuse. Indeed, there have been over 150 False Claims Act lawsuits against hospice providers for admitting ADRD patients whose life expectancy may not have been reasonably evaluated at less than six months, as required by Medicare policy. An open question is how the False Claims Act may in turn have impacted the broader treatment and resulting health outcomes of ADRD patients. We propose to study these impacts. Specifically, to what extent has False Claims Act whistleblowing changed how Medicare beneficiaries with ADRD are treated, both in the realm of hospice care and more generally? What are the patient health consequences of these care changes? And which policy tools are effective at eliminating provider waste, fraud, and abuse without compromising patient care? The parent grant, NBER Center for Aging and Health Research, supports new research development on important questions relating to health at older ages. While the parent grant is not focused on Alzheimer's Disease, this supplement would add to a growing collection of Center-supported research activity on long-term care, particularly among those with cognitive decline.