For the past 10 years, since the enactment of the IRS Whistleblower Office, the IRS has recovered over $3.4 billion because of information submitted by whistleblowers. Out of that sum, $465 million was awarded to whistleblowers. [Read more…]
Justice Department Recovers Over $4.7 Billion In FCA Cases, FY 2016
According to the Justice Department’s Civil Division, the DOJ recovered more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016, making it the third highest annual recovery in FCA history. Since 2009, the Department has regularly recovered above $4 billion per fiscal year, and the total recovery during that period is more than $31.3 billion. [Read more…]
CFTC Proposes New Rules to Strengthen Its Whistleblower Program
The U.S. Commodity Futures Trading Commission (CFTC) is poised to adopt new rules and regulations that will improve the transparency of its whistleblower program while also bolstering protections for whistleblowers. The proposed amendments will also make the CFTC’s program more consistent with the SEC’s whistleblower program, which has already implemented similar rules and regulations.
“Since the whistleblower program was established in 2011, the need for certain improvements has become apparent,” the CFTC stated. By giving whistleblowers “greater clarity about the claims and awards process and greater assurance that retaliation would not be tolerated,” the CFTC believes the proposed rules will “encourage whistleblowers to step forward.”
SEC Whistleblower Program Posts Record Year
The SEC’s whistleblower program paid out a record $57 million to whistleblowers in Fiscal Year 2016. That figure is higher than all previous awards issued through the SEC whistleblower program combined.
According to the agency’s 2016 annual report to Congress, available here, the Office of the Whistleblower received over 4,200 tips and enforcement actions led to $584 million in financial sanctions. The number of tips the office received reflects a 40% increase over FY 2012, the first year the office recorded full-year data. According to the report, the increase in tips is due in large part to the growing awareness of the whistleblower program.
Baby Boomers & Medicare Fraud
The human population is growing at a rapid pace, and in the U.S., this growing population is also aging. The babies born after the Second World War, often referred to as “Baby Boomers,” are now reaching retirement age and eligible for Medicare. The Kaiser Family Foundation reports that almost 10,000 Baby Boomers turn 65 on a daily basis! That’s almost 90 million Baby Boomer eligible for Medicare by 2050. [Read more…]
Perspective on the Tax Gap and the Underutilized IRS Whistleblower Program
In an April 2016 study released by the IRS, the government reported that an average of $406 billion in taxes was not collected each year between 2008 and 2010. The IRS euphemistically calls this the “tax gap,” i.e., the difference between what taxpayers owe and what they actually pay.
What does the tax gap mean to the average taxpayer? [Read more…]
The False Claims Act and the National Association of Medicaid Fraud Control Units (NAMFCU)
After receiving a hefty check in settlement of a False Claims Act case, one of our client relators presented us with a mug saying “G-D Bless NAMFCU.” He wanted to recognize the vital role that NAMFCU played in the investigation, prosecution and settlement of his case. But most relators, especially at the outset of their case, do not know anything about NAMFCU (pronounced Nam-Foo-Koo), or how that organization plays a vital role in assisting relators pursue Medicaid fraud claims brought through a qui tam case. [Read more…]
Qui Tam Lawsuits Recover Billions for the Federal Government in FY 2015
Qui tam whistleblowers who filed cases under the False Claims Act returned nearly $3 billion into the federal treasury in Fiscal Year 2015, according to the U.S. Department of Justice.
False Claims Act cases in the areas of health care, hospital services, mortgage and financial industries, and defense contracting account for the largest part of recoveries. Whistleblower awards during 2015 totaled $597 million.
Supreme Court to Decide “Implied Certification” Issue
SCOTUS to decide the issue of “implied certification” in Universal Health Services v. United States ex rel. Escobar
On December 4, 2015, the Supreme Court granted the defendant United Health Services’ Petition for a Writ of Certiorari to decide, among other things, the issue of whether the “implied certification” theory of legal falsity under the False Claims Act is viable.
Escobar involved a teenaged girl, a Medicaid beneficiary, who was treated by unlicensed workers who had held themselves out to be social workers, psychologists, and psychiatrists, when they were nothing of the sort. Treatment by these workers led to the girl’s death when she was prescribed a drug that caused her to have seizures, one of which was fatal.
Healthcare Fraud Post-ACA
ACA (the Affordable Care Act) expanded healthcare coverage to millions of low-income Americans and put in place numerous reforms within the health insurance sector. Currently, updates to healthcare delivery systems and financing methodologies implemented since ACA was enacted are predicted to result in dramatic reductions in unnecessary medical care in this country. But still, an avalanche of fraud continues to harm healthcare programs, and in particular government programs like Medicare and Medicaid.
Fortunately, powerful anti-fraud provisions in ACA and the False Claims Act have led to revocation of billing privileges for tens of thousands of providers who cheated the government, and Medicare claims are now routinely screened using advanced computer algorithms before being paid. These measures, combined with continued financial incentives for qui tam whistleblowers (called “Relators” under the False Claims Act), will help prevent healthcare fraud and ensure that healthcare coverage post-ACA is provided in a reasonable and cost-efficient manner.