DOJ Recoups More than $1 Billion from Health Care Fraud in FY 2008

WASHINGTON–The United States recovered more than $1.1 billion
lost to fraud in federal health care programs for fiscal 2008, the
Department of Justice said Nov. 10.

Cases involving whistleblowers accounted for a majority of the
recoveries, according to a DOJ release. The figures bring total
recoveries since 1986, when Congress substantially strengthened the
False Claims Act, to more than $21 billion.

The DOJ said almost 78 percent of the recoveries in FY 2008,
ended Sept. 30, were associated with suits initiated by
whistleblowers, called relators, under the False Claims Act’s qui
tam provisions. Under the law, people who knowingly make false
claims for federal funds are liable for three times the
government’s loss plus a civil penalty of $5,500 to $11,000
for each claim.

Relators recover 15 to 25 percent of the proceeds of a
successful suit if the United States intervenes in the qui tam
action, and up to 30 percent if the government declines and the
relator pursues the action alone. In fiscal 2008, relators were
awarded $198 million for their part in bringing successful
cases.

During the year, health care accounted for $1.12 billion of
fraud settlements and judgments. HHS reaped the biggest
recoveries–notably from pharmaceutical companies–largely
attributable to the Medicare and Medicaid programs, the DOJ
said.

“Now more than ever, it is crucial that taxpayer dollars
aren’t lost to fraud,” said Gregory G. Katsas,
assistant attorney general for the DOJ’s Civil Division. He
added that whistleblower complaints do more than recover lost
dollars; they also save much more in “aborted schemes and
misconduct.”