The Justice Department announced that it secured over $3.5 billion in settlements and judgments from civil cases involving fraud against the government in the fiscal year ending September 30, 2015 (“FY2015”). This is the fourth year in a row that the Justice Department has recovered more than $3.5 billion in cases under the False Claims Act (“FCA”) and brings the total recoveries under the FCA to $26.4 billion since January 2009.
The FCA is a federal law prohibiting individuals and institutions from knowingly submitting or causing to be submitted, false or fraudulent claims to the federal government. Most FCA cases are filed under the FCA’s whistleblower, or qui tam, provisions, which allow private citizens to file lawsuits on behalf of the federal government. If they prevail, they can receive up to 30% of the recovery. Qui tam actions often are filed by current or former employees of the companies they accuse of making false claims. Of the more than $3.5 billion recovered by the Justice Department in FY2015, $2.8 billion was related to qui tam lawsuits. During that period, $597 million was paid to individuals who brought qui tam claims.
Health care fraud accounts for the largest percentage of the FCA recoveries, totaling $1.9 million of the FY2015 FCA recoveries. The Justice Department reported it has recovered nearly $16.5 billion in health care fraud from January 2009 through the end of FY2015. The Justice Department attributes this high rate of recovery in the health care industry in part to the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”), which is an interagency task force coordinating the efforts of the Justice Department and the Department of Health and Human Services.
The FCA recoveries in the health care industry stem from a variety of circumstances, including unnecessary or inadequate care, kickbacks paid to health care providers to induce the use of certain goods and services, and overcharging for goods and services paid for by Medicare, Medicaid and other federal health care programs. Hospitals were involved in nearly $330 million in FCA settlements and judgments in FY2015. The Justice Department also noted that the pharmaceutical industry accounted for $96 million in settlements and judgments in FY2015.
Outside the health care industry, the Justice Department reported that in FY2015, government contracts and federal procurement accounted for $1.1 billion in fraud settlements and judgments in FY2015. The Justice Department also noted that it recovered $365 million in housing and mortgage fraud during that period.
In addition to placing an emphasis on FCA cases, in 2015 the DOJ also announced it hired a corporate compliance program expert for a new role in assisting federal prosecutors evaluating whether or not to prosecute companies engaged in fraudulent activity. The compliance expert will help prosecutors evaluate the effectiveness of the company’s existing compliance program and any remedial action taken in response to reports of fraudulent or criminal activity.
It is clear that FCA claims remain a high priority for the Justice Department. In addition, for those companies involved in the health care industry, it is expected that HEAT will continue to aggressively pursue claims of health care fraud. In this environment of multi-million dollar recoveries by both the federal government and individuals filing qui tam actions, one of the most important steps a company can take is to work with counsel to develop and implement a robust compliance program, and to continually monitor the effectiveness of the program and any remedial actions taken in response to complaints.