Study Documents a Decade of Whistleblower-Initiated Legal Action Against Medicare Fraud
In the 1990s, the U.S. Department of Justice (DOJ) increased efforts to combat health care fraud, focusing on false claims made to Medicare and Medicaid programs in particular.
The volume of litigation and financial recoveries related to health care grew quickly, especially among qui tam actions. Qui tam actions are enforcement actions initiated by whistleblowers who are private citizens with inside knowledge of the alleged fraud. By 2005, 90 percent of new health care fraud enforcement actions were initiated by whistleblowers. From 1996 to 2005, the DOJ closed 379 health care fraud cases and recovered $9.3 billion from defendants. Of those cases, the most common targets were provider organizations and billing practices. Although pharmaceutical manufacturers accounted for only 13 of the 379 cases, they accounted for nearly 40 percent of the total recovery because of the very large awards.
Researchers concluded that fraud and abuse may increase during periods of rapid market expansion, but closer government oversight may also be a factor.-American College of Physicians
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