Filing qui tam charges under the federal False Claims Act is one area where litigation delivers financial rewards. It not only benefits the healthcare system, but it also saves money for taxpayers. If their information leads to a significant recovery, whistle blowers who file these qui tam lawsuits are entitled to a part of the earnings. A law student might study the act and the various news releases issued by the US Justice Department to better comprehend the False Claims Act.
During Abraham Lincoln’s presidency, the Federal False Claims Act (FCA), 31 U.S.C. 3729 – 3733, was adopted to assist the government in collecting money from contractors and people who filed false bills to the US Department of Defense. The FCA has subsequently been amended to protect Medicare, Medicare Part D, Medicaid, and TRICARE (medical insurance for veterans’ families) from bogus claims.
Abraham Lincoln University (ALU) is an institutionally recognized for-profit online university, although its law school is an unaccredited for-profit online law school.
Recent False Claims Act Settlements and Judgments in Healthcare
According to a news release issued by the US Department of Justice (DOJ) on January 9, 2020, the DOJ acquired more than $3 billion in civil judgments and settlements for the fiscal year that ended September 30, 2019. The total amount of recovery since the last substantial amendment to the FCA by Congress (in 1986) is more than $60 billion.
False claims in the healthcare business accounted for the majority of the $3 billion in recovery. Nearly $2.6 billion in recoveries were involved:
- Hospice service providers
- Manufacturers of medical devices
- Managed care organizations
According to the DOJ news release, the department has now recovered more than $2 billion in false healthcare claims for the eighth year in a row. While the $2.6 billion recovery figure indicates recoveries from federal healthcare fraud, millions of dollars have also been recovered for state Medicaid programs as a result of federal False Claims Act actions.
However, False Claims Act actions do more than only assist federal healthcare programs in recouping cash for bogus claims. It contributes to the integrity of the healthcare system by requiring health practitioners to follow the rules. The FCA also protects patients by ensuring that patient safety and health take precedence above financial incentives for health professionals.
The False Claims Act includes mechanisms for handling claims made by whistleblowers who reveal healthcare fraud. Whistleblowers can get 10-30% of any recovery, based on the value of the revealed information, if the DOJ decides to intervene (accept) the claim, and the extent of the recovery. The prize is based on a complete recovery. A complete recovery includes the amount paid to the billing healthcare provider by the government agency, such as Medicare. It can also include triple damages, statutory damages for each False Claims Act violation, and interest.