The U.S. Justice Department regained $3.8 billion through civil cases involving fraud committed against the government in the fiscal year ending Sept. 30, with $2.6 billion in healthcare fraud recoveries, according to a recent DoJ announcement. This represents the second largest annual recovery of its type in history, bringing the total dollars recouped since 2009 under the False Claims Act to $17 billion.
The False Claims Act is the federal government's go-to instrument for recovering money inappropriately paid by healthcare programs including Medicare and Medicaid. Fraud cases investigated under the Act return $20 for every $1 invested in them, as FierceHealthPayer reported.
In 1986, Congress put sharper teeth into the Act by increasing incentives for whistleblowers to bring civil actions on behalf of the government. This multiplied investigations and savings: Recoveries in qui tam cases this year totaled $2.9 billion, the DoJ announcement said, with whistleblowers receiving a $345 million slice of that pie.
"These recoveries would not have been possible without the brave contributions made by ordinary men and women who made extraordinary sacrifices to expose fraud and corruption in government programs," said Stuart F. Delery, assistant attorney general for the civil division in the announcement. Delery called the recoveries "a strong deterrent" to others bent on defrauding government programs.
Fighting healthcare fraud and recovering overpayments resulting from it are top priorities of several federal agencies, including the Office of Inspector General.
Here are three noteworthy examples from 2013:
- Abbot Labs paid $1.5 billion to settle allegations that it illegally promoted a drug to treat aggression and schizophrenia when neither of these uses was approved by the Food and Drug Administration.
- Amgen, Inc. paid the government $762 million to settle allegations that included illegal promotion of a drug used to treat anemia.
- And Caremark, LLC agreed to pay the federal government and five states $4.25 million to resolve allegations that it intentionally denied Medicaid claims on behalf of beneficiaries covered by both Medicaid and private insurers.
- here's the DoJ announcement