The health care field reflects the source of the greatest dollar amount of FCA violation judgments and settlements. As reported in a Department of Justice press release, the 2021 fiscal year accounted for the DOJ’s collection of greater than $5.6 billion from FCA violations; over $5 billion came from the health care industry.
The DOJ also notes that the 598 actions initiated by whistleblowers represented a significant portion of the FCA violations pursued in 2021. If you become aware of a False Claim Act violation and report it to the proper authorities, you may receive an award based on a percentage of funds collected.
What type of fraud occurs within health care?
The range of FCA violations occurring in health care includes billing for unnecessary medical treatments and failing to disclose product side effects or adverse reactions. Kickbacks also occur, whether made to other providers or to care recipients. These violations carry the potential to derail unbiased decision-making regarding medical products and treatments.
The opioid epidemic brought about actions representing the largest FCA settlements. In one well-reported case, the federal government held the manufacturer of OxyContin accountable for their intensified marketing program. The manufacturer directed its marketing at the high-volume prescribers that allowed the addictive drug to become available to individuals prone to abuse.
Where did other significant FCA violations occur?
The DOJ notes that companies providing services and goods to the government also bring about a variety of enforcement actions. In one case, a defense manufacturer settled for $50 million after allegations of defrauding the U.S. Marine Corps surfaced. Another case involved a $25 million settlement from a manufacturer defrauding the U.S. Navy.
If your employment places you as an insider in your field, you could play a vital role in ending fraud. Within the health care field, the actions taken could also save patients’ lives.