By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.
The Third Highest Annual Recovery.
Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.
“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”
Fraud in the Health Care Industry.
The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.
Click here to read the DOJ’s press release in full.
These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.
To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.
If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.
Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.
Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.
Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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