According to the US Department of Justice, 2018 was another banner year for whistleblowers and False Claims Act cases. The DOJ settled or obtained verdicts in cases worth more than $2.8 billion. Whistleblowers can bring actions under the False Claims Act against individuals and businesses that commit fraud against Medicare, Medicaid, the Department of Defense, and other agencies. There are also whistleblower authorized lawsuits involving the IRS, the SEC, the CFTC, and other federal agencies. California also has a False Claims law for fraud involving California agencies.

$2.1 billion of the $2.8 billion in settlements and verdicts were due to cases initiated through whistleblowers. The other payments were likely due to claims initiated directly by the federal government. Whistleblower claims are commonly called qui tam claims. The False Claims Act authorizes that whistleblowers should be entitled to a substantial percentage of any recovery (up to 30 %) – payment for the amount of fraud and statutory damages. In 2018, whistleblowers were paid more than $300 million for disclosing fraud. 645 claims, an average of 12 weekly, were filed in 2018.

Whistleblowers generally consult with experienced False Claims Act lawyers for several reasons. Experienced lawyers advise whistleblowers on the proper time and method of their disclosure. For example, whistleblowers need to be the first to disclose the wrong in order to claim a percentage of the recovery.

Most of the $2.8 billion in recoveries were due to fraud in the health care sector. Defendants included:

  • Drug and medical device manufacturers
  • Managed care providers
  • Hospitals
  • Pharmacies
  • Hospice organizations
  • Laboratories
  • Physicians.

While the health care recoveries “reflect only federal losses, the Department was instrumental in recovering additional millions of dollars for state Medicaid programs.”

In addition to fraud involving Medicare and Medicaid, the False Claims Act covers fraud involving TRICARE – a healthcare system for the nation’s military personnel, veterans, and their dependents.

Some examples of health care fraud recoveries in 2018

A few of the cited health care fraud cases were:

  • AmerisourceBergen Corporation. This company and some of its subsidiaries paid $625 million to settle charges they tried to navigate around drug safety standards by repackaging certain drugs supplied to patients with cancer. In this case, $581.8 million was payable to the federal government and the rest to state Medicaid programs.
  • Alere. This medical device manufacturer paid $33.2 million to settle complaints the company sold a medical device that had not been properly tested even though the device was meant to help diagnose “drug overdoses, acute coronary syndrome and other serious conditions.” Again, the bulk of the funds were payable to the federal government and some went to state Medicaid programs.
  • United Therapeutics Corporation. This company sold pulmonary arterial hypertension (PAH) drugs. It paid “$210 million to resolve allegations that it used a foundation as an illegal conduit to pay the co-pay obligations of thousands of Medicare patients taking its PAH drugs.” Co-pays are a way of providing a check on health care costs.
  • Pfizer. This drug manufacturer paid nearly $23.85 million to settled allegations it also used a foundation to pay the co-pays of Medicare patients who bought drugs made by Pfizer. The DOJ claimed that Pfizer “raised the price of one of those drugs by 40 percent in just three months. “

Speak with an experienced California False Claims Act lawyer as soon as you learn of the fraud

Time matters. Delays in contacting skilled quit tam lawyers can mean the difference between a valid claim and having someone else file their claim first. For help with all aspects of any whistleblower claim, please call the law office of Stephen Danz & Associates, today. We have offices throughout the state. You can reach us at 877)789-9707 to schedule an appointment. Se Habla Espanol.