Whistleblowers and Whistleblower Attorneys Make 2013 A Very Bad Year for Healthcare Fraud

The False Claims Act has proven unparalleled in its effectiveness in recovering money improperly obtained by fraudulent businesses and individuals. In recent years, the FCA has proven especially useful in exposing and punishing those engaging in healthcare fraud. Healthcare fraud, generally speaking, involves the submission of fraudulent invoices to programs like Medicaid or Medicare for reimbursement. Misconduct in the healthcare industry often involves any of the following scams:

• “Upcoding-“ The practice of entering false codes for services either never rendered or for more costly services than those actually rendered;
• Allowing nurses to perform work and billing at a doctor’s rate;
• Ordering unnecessary tests and procedures in order to collect additional reimbursement;
• Billing for hour-long visits with the physician when the patient actually only saw a nurse;
• Diagnosing patients with conditions they do not actually have.

2013 Second-Highest Year for Overall FCA Recoveries

According to a recent report published by the Justice Department, $3.8 billion in settlements and judgments were recovered on behalf of American taxpayers under the FCA. The report covers the entire fiscal year 2013, which drew to a close on September 30, 2013. Since January, 2009, the FCA has been used to recover $17 billion, a figure representing half of all total recoveries since the FCA was amended in 1986. Additionally, the DOJ reports having recovered $3 billion or more for the fourth year in a row.

Healthcare Fraud Recoveries

In fiscal year 2013, the DOJ recovered $2.6 billion in health care fraud settlements and judgments. According to the DOJ, this success rate is due, in part, to the high priority placed on combatting health care fraud by the current administration, as evidenced by its creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). This task force is designed to coordinate and optimize enforcement both civilly and criminally.

The largest recoveries in calendar year 2013 involved healthcare fraud, including a landmark case settled by our office. Out of the total yearly FCA recovery, $1.8 billion was reclaimed following false claims involving drugs and medical devices. The DOJ saw an increase in the improper promotion of drugs for uses not approved by the Food and Drug Administration (FDA), a practice known as “off-label marketing.” One of the largest recoveries, topping $1.5 billion, resolved several allegations against drug maker Abbot Laboratories for improperly marketing certain drugs for the sedation of elderly dementia patients – a use not approved by the FDA.

Help Make 2014 a Record-Breaking Anti-Fraud Year

Fiscal year 2014 is already underway and will hopefully reap even greater benefits under federal and state anti-fraud statutes than those recovered in 2013. If you suspect fraud by your healthcare provider, do not hesitate to contact a whistleblower attorney with your suspicions right away.