The U.S. Department of Justice (DOJ) recently announced that it recovered more than $5.6 billion from False Claims Act cases in fiscal year 2021—the second-highest amount ever recovered in a single year. According to the DOJ, more than $1.6 billion of the $5.6 billion in settlements and judgments in fiscal year 2021 resulted from lawsuits filed under the qui tam provisions of the False Claims Act (FCA).

The qui tam provisions of the FCA allow individuals with evidence of fraud being committed against the government to file a lawsuit on behalf of the United States. As a reward for coming forward and reporting the fraud, whistleblowers can receive up to 30% of the total money recovered.

In fiscal year 2021, the United States paid out $237 million to whistleblowers who exposed fraud against the federal government. Whistleblowers filed 598 qui tam suits in 2021, with an average of more than 11 cases a week. Below are some examples of FCA violations the DOJ pursued last year.

Healthcare Fraud

As in previous years, the majority of FCA cases in 2021, totaling more than $5 billion in recoveries, were related to fraud involving the healthcare industry, including drug manufacturers, hospitals, pharmacies, and doctors. Common healthcare fraud schemes include fraudulent patient assistance programs, hospice fraud, lab test fraud, and medical necessity related fraud.

The DOJ investigated a growing number of cases involving risk adjustment fraud related to the Medicare Advantage program. Plans and healthcare providers that manipulate the patients’ risk factors in order to receive inflated payments are committing fraud against the government. Healthcare services provider Sutter Health paid $90 million last year to resolve allegations that the company submitted falsified patient diagnosis codes in order to receive inflated payments.

Kickbacks

Kickbacks in the healthcare industry can have many negative consequences. Sometimes, patient care is compromised when doctors prescribe certain drugs not because they are the best treatment, but because the doctor is receiving bribes from the drug manufacturer. Other times, patients may not receive the best care because a company instead paid for access to hospitals and doctors’ offices instead of legitimately qualifying for it. Last year, for example, Athenahealth Inc., an electronic health records (EHR) vendor, agreed to pay more than $18.25 million to resolve allegations that they violated the Anti-Kickback Statute by inviting customers and potential customers to lavish trips and events to generate sales of its software.

Medical Necessity Fraud

Federal healthcare programs, such as Medicare, Medicaid, and TRICARE, spend more than $1 trillion each year to cover healthcare costs for millions of individuals. Some companies seek to take advantage of that large budget and take more than they should. When healthcare providers bill these federal healthcare programs for medically unnecessary treatments, they are in violation of the False Claims Act and are subject to civil and criminal penalties. Last year, for instance, SavaSeniorCare LLC agreed to pay $11.2 million to resolve allegations that the company was providing substandard care and unnecessary services to Medicare patients.

Government Contracting Fraud

The federal government is the world’s single largest purchaser of goods and services. Unscrupulous contractors have come up with numerous fraudulent schemes to cheat taxpayers out of the hundreds of billions of dollars the government spends each year. Many cases involve companies that lie during the contract negotiation process—such as Navistar Defense LLC, which paid $50 million to resolve allegations that it fraudulently induced the U.S. Marine Corps to enter into a contract modification at inflated prices. Other cases involve defective or substandard goods or services. For example, United Airlines paid $32.1 million after allegedly failing to meet the delivery standards required by its contract with the U.S. Postal Service.

Contact Us

Whistleblowers are essential in the investigation and prosecution of fraud being committed against the federal government. If you have information about any type of False Claims Act violations, you should seek the guidance of a whistleblower attorney.

With more than 30 years of experience, the attorneys on Baron & Budd’s whistleblower representation team have represented dozens of clients in government fraud cases returning over $5.4 billion to federal and state agencies, with whistleblower recovery shares as high as 49%. They are ready to help if you have evidence of fraud against the government.

Please call (866) 845-2164 or complete our contact form if you would like more information. For more information, see What You Need to Know About Becoming a Whistleblower.  Please understand that contacting us does not mean that you have established an attorney-client relationship with Baron & Budd, P.C.