FY 2010 A Positive One for Combating Health Care Fraud
In response to a formal inquiry by Senators Charles Grassley (R-IA) and Patrick Leahy (D-VT), on January 24, 2011, the Department of Justice (“DOJ”) and Health and Human Services (“HHS”) issued a joint response detailing the nature and scope of False Claims Act cases both under seal and resolved by the Department of Justice as of January 4, 2011.
According to the response letter, as of January 4, 2011, there were 1,341 qui tam cases under investigation, 885 of which allege some form of health care fraud. Of those 885 cases, 867 actually involve Medicare or Medicaid. Although, there have been no intervention decisions as to any of the aforementioned cases, the sheer volume of cases pending appears to suggest that Americans are becoming less tolerant of fraud and more willing to step forward.
Impressively, over the course of the last five years, the Civil Division of the Department of Justice, in connection with United States Attorneys’ offices, has obtained 541 settlements and judgments in qui tam actions totaling approximately $9.6 billion. Further, since the beginning of the 2011 fiscal year alone, the Civil Division has obtained 19 settlements and judgments totaling more than $1.2 billion.
In addition to the civil fines and penalties, the joint response also addresses DOJ’s tendency to favor parallel civil and criminal proceedings when it is in the best interest of the United States. By way of example, the response points to the area of pharmaceutical fraud which, since January 2009, has resulted in the recovery of more than $3 billion in criminal fines, forfeitures, restitution, and disgorgement, as well as 26 convictions.
While there is always room for improvement, ultimately, FY 2010 rendered impressive statistics in the ongoing effort to combat health care fraud, including a 16% increase over FY 2009 in the number of defendants charged.
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