Whistleblowers help fight healthcare fraud

Whistleblowers are becoming an increasingly powerful weapon against healthcare fraud. And the industry will likely see more whistleblower lawsuits this year, especially as states look to qui tam settlements to pad their tight budgets, The Wall Street Journal reported.

More than 60 percent of fraud recoveries in 2012 stemmed from qui tam provisions, according to U.S. law firm Gibson Dunn & Crutcher.

Last year, the U.S. Justice recouped nearly $3 billion in healthcare fraud recoveries under the False Claims Act for the first time in a single year, shattering previous records by more than $1.7 billion.

That figure doesn't even include the $745 million recovered for state Medicaid programs, noted Gibson Dunn & Crutcher.

Noteworthy whistleblower settlements at the close of 2012 included Florida's BayCare Health System's $10.1 million settlement of claims it overbilled for certain cardiac procedures, as well as North Carolina's WakeMed Health & Hospitals' $8 million agreement to resolve allegations it improperly billed for overnight care.

Florida, in particular, has had large success uncovering healthcare fraud with the help of whistleblowers, the Palm Beach Post reported. Of the $162 million recovered, roughly $145 million stemmed from civil settlements including whistleblower cases.

The state's efforts to prevent Medicaid fraud also have yielded a strong return on investment, where the state gained $6.80 for every dollar spent on fraud prevention and recovery.

For more:
- here's the WSJ blog post (subscription required)
- read the Gibson Dunn & Crutcher article
- read the Palm Beach Post article