Do you like a good return on your investments?
So does the federal government, and when it comes to healthcare-fraud enforcement, it’s doing pretty darn well.¬†How well? Try $8.10¬†for every $1 spent, and yes, you’re reading correctly. That’s more than $8¬†in recoveries¬†for every $1¬†that was spent investigating and prosecuting healthcare fraud over the last three fiscal years (2011-13).
So says a joint report released last month by the Department of Justice and the Department of Health and Human Services. The report details the¬†government’s use of civil and criminal statutes to recover taxpayer money¬†under its Health Care Fraud and Abuse Control Program. With¬†numbers like that, it’s no wonder healthcare-fraud enforcement continues to be a high-priority area.
Overall, healthcare-fraud recoveries totaled¬†$2.6 billion in FY 2013. Most of that related to fraud against Medicare and Medicaid but some of it involved¬†adulterated drugs or off-label marketing under the Food, Drug, and Cosmetic Act, among other things.
Beyond healthcare fraud, another $1 billion in recoveries came from the pursuit of so-called procurement fraud, which relates to government contracts. Most of that came from¬†one $664 million judgment against a¬†defense contractor that¬†was the largest judgment in the history of the¬†False Claims Act.¬†The FCA is¬†the government’s primary civil tool for combating false claims for public funds¬†or property under government contracts (like defense contracts) and government programs (like Medicare).
Add it all up, and the government recovered nearly $4 billion in 2013 from settlements and judgments¬†under the False Claims Act. Most of those cases were filed under the whistleblower, or qui tam, provisions of the Act, which allow private citizens to¬†sue on behalf of the government. If the lawsuit is successful,¬†a whistleblower can receive up to 30% of the recovery. In¬†FY 2013, for example,¬†the government recovered $2.9 billion in qui tam cases, and¬†whistleblowers received $345 million.