It was another record-setting year at the Department of Justice (DOJ) for the prosecution of healthcare fraud. The DOJ recovered over $2.4 billion in civil cases of healthcare fraud in fiscal year 2011 under the False Claims Act. The majority of the $2.4 billion recovered was the result of whistleblower or qui tam actions.
Whistleblower actions allow private citizens to file lawsuits on behalf of the government if the whistleblower has knowledge of healthcare fraud against the government. If the government is successful in recovering money, the whistleblower is entitled to a portion of the recovery. Civil cases of healthcare fraud do not always involve an intent by a healthcare provider to defraud the government. To the contrary, technical violations of the Anti-Kickback Statute or the Stark law, such as employing a physician without a written employment agreement, can lead to severe penalties under the False Claims Act.
Healthcare fraud and abuse has been a top priority for the DOJ in the past few years. Since January of 2009, the DOJ has recovered over $6.6 billion in federal healthcare dollars, which is more than in any other three-year period in the history of the DOJ.