In 2013, the Department of Justice recovered $3.8 billion under False Claims Act, the bulk of which stemming from claims for health care fraud. The Obama Administration has been more aggressive in pursuing qui tam cases than previous administrations, and as a result, recovered over $2.9 billion from whistle blower lawsuits (while whistle blowers collected $345 million). The fact that the bulk of these recoveries ($2.6 billion) were for health care fraud, this puts renewed focus on providers to maintain compliant practices in all manners of operation to ensure compliance with applicable laws and regulations.
Of these recoveries, 752 claims were brought as qui tam actions by whistleblowers. A qui tam action involves a suit initiated by an individual, or “relator,” who with the help of the government, alleges that the defendant violated certain federal laws, including the Federal False Claims Act. Individuals who file under the False Claims Act are entitled to receive a portion of the monetary recovery from the defendant (normally between 15-25%).
Under the False Claims Act, a defendant can be liable if it knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval or knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim. For example, by violating the Federal anti-kickback laws in one way or another, a health care provider will be deemed to be submitting false claims to the government because it must otherwise certify compliance with government requirements.
The best way for providers to avoid these types of qui tam cases is to make sure your healthcare business is following Federal and State law. Frier Levitt assists healthcare businesses of all kinds comply with laws and regulations, and avoid potential liability. Contact us to speak to an attorney
