The False Claims Act allows private parties -- often the employees of companies that contract with the government -- to file lawsuits on the government's behalf. When these whistleblowers have evidence of fraud, waste or abuse in a government contract, they can sue to help the government reclaim the money. In exchange for their service, the whistleblowers receive between 15 and 30 percent of the total recovery as a reward.
The Department of Justice has accused Lockheed Martin Corporation, certain affiliated companies, and at least one executive of making false claims against the government and accepting kickbacks in regard to a multibillion-dollar contract. The contract was to clean up a nuclear site in Hanford, Washington.
"Patients and taxpayers rightly should expect that referrals be based on sound medical judgement, not driven by thinly veiled bribes, as alleged here," said a spokesperson for the U.S. Department of Health and Human Services Office of Inspector General.
"By bringing allegations of fraud to light, whistleblowers play an important role in protecting the integrity of our healthcare system," says the U.S. Attorney for the Western District of Pennsylvania.
As drug prices rise in the U.S., some have expressed concerns that charitable payment of drug copays could be contributing to price inflation. This is because, although most patient assistance groups of this type are charities, pharmaceutical companies routinely donate to the groups.
When someone blows the whistle on fraud, waste or abuse in federal programs, they can often receive as a reward a substantial portion of any money recovered on behalf of the government. This is called the qui tam provision of the federal False Claims Act. In a recent pair of consolidated False Claims Act cases, the whistleblower will receive a reward of $5,411,521.
The federal government intervened in eight False Claims Act lawsuits and brought criminal charges against Health Management Associates, LLC (HMA), a hospital chain that has since been sold. According to the Justice Department, HMA engaged in a scheme to defraud the U.S. The allegations include:
It has been reported that Post Acute Medical, LLC, and certain affiliates ("PAM") have agreed to pay $13,168,000 to settle claims by the Justice Department, Texas and Louisiana that they violated the False Claims Act and parallel state statutes. The nationwide operator of rehabilitation and long-term care hospitals was accused of knowingly submitting claims to Medicare and Medicaid that were the result of violations of the Physician Self-Referral Law and the Anti-Kickback Statute.
A Texas doctor will receive $4.9 million as a reward for blowing the whistle on seven ambulance industry defendants who allegedly paid kickbacks to municipal entities in several states in exchange for lucrative ambulance business. The alleged kickbacks violated the federal Anti-Kickback Statute, which prohibits offering, paying, soliciting or receiving remuneration in order to induce referrals. The scheme allegedly resulted in false claims being submitted to Medicare and Medicaid, which violated the False Claims Act.
Pharmaceutical manufacturer Insys Therapeutics, Inc., has tentatively agreed to settle allegations by the U.S. Justice Department that it paid kickbacks to doctors in order to get them to prescribe its drug Subsys. The drug is an under-the-tongue spray containing the opioid fentanyl, which is some 100 times stronger than morphine. Subsys was intended to manage pain in cancer patients.