This second part in our ongoing series reviewing health care fraud enforcement activities in 2011,i/ and monitoring enforcement in 2012, expands upon our prior discussion in part one (Part One Report) of the federal False Claims Act (FCA)—the government’s primary and most powerful civil health care fraud enforcement tool. The FCA has been used with substantial success in past years to recover funds paid by the government allegedly for (1) services billed but not provided; (2) services provided but not billed in accordance with statutory or regulatory requirements, or administrative guidelines; and (3) services provided and accurately billed but not provided in compliance with an underlying statutory, regulatory, or contractual obligation. In 2011, this trend continued and accelerated.
Much of the FCA’s power comes from its qui tam provisions, which permit private relators (often called “whistleblowers”) to bring claims under the FCA on behalf of the government and which reward them financially for doing so successfully. The Department of Justice (DOJ) reported recovering $2.8 billion in settlements and judgments under the FCA’s qui tam provisions last year. By far the largest portion of the 2011 settlement amounts—$2.4 billion—related to federal health care programs. In addition, the DOJ reported that the number of qui tam lawsuits in 2011 increased significantly—rising from between 300 and 400 cases per year to 638.
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