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Feds get more than $5 billion in healthcare related false claims cases

The United States Department of Justice (DOJ) recently reported that it recovered $5.6 billion in settlements and judgments from civil false claims cases in 2021. This is significant as it marks the second-largest total of recovered funds under the False Claims Act (FCA) in the history of this federal law.

Even more notable: the vast majority (90%) of these funds were the result of healthcare related cases. 

What do I need to take away from this report?

The government is aggressively pursuing these types of cases. Brian Boynton, the acting Assistant Attorney General for the DOJ’s Civil Division, made it clear that the government is prioritizing the investigation of allegations of FCA violations.

How does the government begin an FCA case?

These cases are often started by a co-worker, employee, contractor, or other individual that initiates the lawsuit — not the government. After initiated, the government may choose to join the case. These are known as whistleblower cases.

It is important to note that the government has set these cases up to incentivize individuals to move forward with filing the lawsuit. If successful, the individual can get up to 30% of any funds recovered by the government.

Who is at risk of allegations of an FCA violation?

Organizations that bill Medicare, Medicaid and similar health insurance providers can face allegations of an FCA violation. The DOJ states it will investigate allegations of these types of violations in hospitals, managed care providers, hospice organizations, labs, and physicians as well as any drug or medical device manufacturers.

What if the government accuses my organization of an FCA violation?

The government is likely looking for evidence that your organization intentionally filed a false claim for payment. It is important to take good records to support billing and use this information to help build a defense against these allegations.

Attorney John Rivas is responsible for this communication