Another Banner Year for Healthcare Fraud Enforcement and the False Claims Act

Do you like a good return on your investments?

So does the federal government, and when it comes to healthcare-fraud enforcement, it’s doing pretty darn well. How well? Try $8.10 for every $1 spent, and yes, you’re reading correctly. That’s more than $8 in recoveries for every $1 that was spent investigating and prosecuting healthcare fraud over the last three fiscal years (2011-13).

So says a joint report released last month by the Department of Justice and the Department of Health and Human Services. The report details the government’s use of civil and criminal statutes to recover taxpayer money under its Health Care Fraud and Abuse Control Program. With numbers like that, it’s no wonder healthcare-fraud enforcement continues to be a high-priority area.

Overall, healthcare-fraud recoveries totaled $2.6 billion in FY 2013. Most of that related to fraud against Medicare and Medicaid but some of it involved adulterated drugs or off-label marketing under the Food, Drug, and Cosmetic Act, among other things.

Beyond healthcare fraud, another $1 billion in recoveries came from the pursuit of so-called procurement fraud, which relates to government contracts. Most of that came from one $664 million judgment against a defense contractor that was the largest judgment in the history of the False Claims Act. The FCA is the government’s primary civil tool for combating false claims for public funds or property under government contracts (like defense contracts) and government programs (like Medicare).

Add it all up, and the government recovered nearly $4 billion in 2013 from settlements and judgments under the False Claims Act. Most of those cases were filed under the whistleblower, or qui tam, provisions of the Act, which allow private citizens to sue on behalf of the government. If the lawsuit is successful, a whistleblower can receive up to 30% of the recovery. In FY 2013, for example, the government recovered $2.9 billion in qui tam cases, and whistleblowers received $345 million.