Health care fraud and false claims pose a serious financial threat to the federal government and tax payers alike. The Department of Justice (DOJ) works in conjunction with ordinary citizens and public servants to pursue justice against those committing the fraud.
By the numbers
In the 2017 fiscal year, the DOJ obtained more than $3.7 billion in settlements and judgments from cases involving fraud and false claims against the federal government. $3.4 billion was related to lawsuits filed under qui tam provisions, leading to $392 million paid out to whistleblowers that exposed the fraud. Over $2.4 billion was for health care fraud, which occurred in all areas of the industry including drug manufacturers, pharmacies, hospitals, laboratories and physicians. The recovery efforts restore monies to federally funded programs, such as Medicare and Medicaid.
Keep in mind, these figures only represent federal losses and millions of additional losses for state programs were also recovered. When scams occur, they impact state and federal resources and recovery efforts benefit both governments.
Some of the largest recoveries for health care fraud were from drug and medical device companies using illegal tactics to sell more products. Drug manufacturers and device makers offered kickbacks for those selling their product including paid travel and entertainment, wining and dining at lavish restaurants and even cash payments. A drug company was also accused of purposefully misclassifying a brand name drug as a generic drug in order to pay lower rebates to the Medicaid Drug Rebate Program.
Health care providers over charging for work or charging for services not performed were another problem. A nursing facility provider was caught submitting false claims for patients and overcharging for unnecessary treatments in order to collect more money. The company also tried to keep patients in facilities longer in order to continue billing for patient care.
While one hopes the pursuit of justice for Medicare or Medicaid fraud would deter a prospective contributor that is unlikely the case and more abuses will be discovered down the road. If you have proof of fraud against the government, you can pursue a qui tam lawsuit and help stop the fraud.