The purpose of the qui tam provisions of the False Claims Act is to encourage private individuals who are aware of fraud being perpetrated against the government to bring such information forward.

Supporters of managed care argue that HMOs correct the traditional fee-for-service of overutilization. No longer, they assert, will physicians have the financial incentive to overtreat or overutilize procedures.

Unfortunately, the incentives for managed care (HMO) executives now may result in a lack of care, or "underutilization." Conduct which may give rise to False Claims Act violations include:

• systematic failure to authorize medically necessary treatments;
• systematic false representations to consumers to induce enrollment.

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