Nearly All 2013 Health Care Fraud Recoveries Identified in Annual HCFAC Report Were Attributable to Whistleblowers

The opening paragraph of the federal government’s 2013 Health Care Fraud and Abuse Control (HCFAC) report states that the “Program’s continued success confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud and abuse, and to protect program beneficiaries.” The report goes on tout the $4.3 billion recovered “through its health care fraud prevention and enforcement efforts.” While the federal government, most assuredly, played an important role in recovering these funds, the HCFAC report seems to gloss over its junior fraud-fighting partner—qui tam relators.

The vast majority of the recoveries identified in the report stemmed from less than 100 civil False Claims Act qui tam actions and related criminal proceedings. In fact, nearly all of the recoveries itemized in the report were from whistleblower-initiated lawsuits, where private citizens exposed the alleged wrongdoing of various healthcare providers.

This trend will likely continue for the foreseeable future, for report notes that the Justice Department opened 1,083 new civil health care fraud investigations in fiscal year 2013. The number of new civil investigations marks a substantial increase over previous years, as seen in prior HCFAC reports.

Once again, this annual report highlighted the pivotal role that whistleblowers played in recovering our nation’s stolen healthcare dollars. Indeed, while the federal government paid over $325 million in whistleblower rewards in 2013, this payout represented a small fraction of the multi-billion dollar recoveries that resulted from whistleblower actions. Perhaps next year’s HCFAC report will explicitly state this reality.