2013 proved to be another record-setting year for False Claims Act lawsuits, the largest of these recoveries related to health care fraud. The Department of Justice (“DOJ”) secured $3.8 billion from False Claims Act settlements and judgments during the 2013 fiscal year.1
In 2013, the government recovered $2.6 billion in health care fraud, which marked the fourth year in a row that the DOJ has recovered more than $2 billion in cases involving health care fraud. The Obama Administration has placed a high priority on fighting health care fraud, leading to a significant growth of health care related False Claims Act cases, including qui tam actions, in recent history.2
$2.9 billion of the $3.8 billion recovered by the DOJ related to lawsuits filed under the qui tam provisions of the False Claims Act. A qui tam lawsuit is a type of civil lawsuit brought by a whistleblower under the False Claims Act. The DOJ then investigates whether it wants to join in the lawsuit. If the lawsuit brought by the whistleblower or the DOJ is successful, the whistleblower is entitled to a percentage of the judgment. In addition to monetary benefits, qui tam lawsuits also provide whistleblowers with job protection.
Qui tam actions against health care providers have increased. Health care providers should take the following actions to avoid becoming the subject of a qui tam lawsuit:
Implement policies, procedures, and compliance plans as required by State and Federal law to prevent fraud and abuse and to ensure optimal patient care.
Conduct regular in-service training for all employees to ensure compliance with the policies and procedures and to guarantee compliance with all regulatory requirements relative to billing and patient care.
Carefully review all contracts to ensure compliance with the applicable State and Federal laws and regulations.
Create a professional and transparent environment that fosters successful communication between employees and management. Implement a safe and effective procedure for employees to report problems or improper conduct directly to management. Management should be responsive and proactive to employee reports.
Perform regular and systematic internal monitoring to ensure that all policies, procedures, rules, and regulations are being followed. If a problem is discovered, correct the problem immediately.
1 Justice Department Recovers $3.8 Billion from False Claims Act Cases in Fiscal Year 2013: http://www.justice.gov/opa/pr/2013/December/13-civ-1352.html.
2 From January 2009 through the 2013 fiscal year end, the DOJ used the False Claims Act to recover $12.1 billion of federal health care dollars, mostly related to Medicare and Medicaid fraud.