Department of Justice faces 500-case healthcare whistle-blower backlog

In theory, having scores of whistle-blowers file cases identifying potential fraud is a good thing. However, a recent surge in such cases has so overwhelmed staff at the U.S. Department of Justice that they're facing a backlog of more than 900 cases claiming that companies have defrauded the federal government, 500 of which involve pharmaceutical and healthcare firms. 

Since 2001, whistle-blowers have filed 300 to 400 civil cases each year, but the 75-lawyer unit charged with reviewing such allegations only has the capacity to investigate about 100 cases each year. For that reason, whistle-blowers may wait more than a year to find out whether the DoJ is even prepared to move forward with their case. While the DoJ rejects about three-quarters of such cases as lacking merit, it's also made some spectacular cases work. In one striking example, it reached a $650 million settlement with Merck this year in connection with their alleged failure to repay Medicaid rebates.

Even given the constraints the agency faces, it has managed to collect almost $13 billion in recent years. Given this success, advocates are increasingly pressing for DoJ to invest more resources in catching up on the backlogged filings.

To learn more about this issue:
- read this Kaiser Daily Healthcare Policy Report article

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