.jpg)
For the fiscal year ending September 30, 2014, the U.S. Department of Justice obtained a record $5.69 billion in settlements and judgments from cases involving fraud and false claims. Fiscal year 2014 was the first time the DOJ exceeded 5 billion dollars in recovery under the False Claims Act, and total recoveries from January 2009 through the end of fiscal year 2014 totaled 22.75 billion dollars. For 2014, false claims recoveries against federal health care programs such as Medicare and Medicaid totaled 2.3 billion dollars for federal losses, which did not include recoveries of additional monies for consumers and state treasuries.The False Claims Act permits the government to pursue causes of action for false claims made for government funds or property, and under government contracts, which also includes Medicare. Primarily claims under the False Claims Act are filed under the Act’s whistleblower/qui tam provisions which allows individuals to file lawsuits alleging false claims on behalf of the government. If the government prevails in the action, the individual whistleblower, also known as a relator, can recover up to 30 percent of the recovery.
Most recently, a large hospital chain agreed to pay the federal government a substantial sum of money to settle a 2005 whistleblower lawsuit for allegations of wrongdoing. As part of the settlement, the hospital chain denied any wrongdoing.
Given the enactment of the Affordable Care Act, it appears questionable payments will be more carefully scrutinized and claims more vigorously pursued. Healthcare providers across the board should be vigilant in their billing practices by, amongst other things, carefully choosing contractors to perform billing functions, and closely supervising contractors and employees to confirm that they are knowledgeable and diligently following government regulations for filing claims.
