Healthcare is the largest single cost in the federal budget – approximately 22 percent of the total — and the cost increases dramatically from year to year. With fraud following that money, the government is highly incentivized to investigate and prosecute corruption in the healthcare and pharmaceutical industries.
False Claims Act violations involve making fraudulent medical billing claims for payment from the government healthcare programs. One of the largest programs is Medicaid, healthcare for the indigent. Fraudulent conduct can involve overbilling, or receiving payments under these programs while not in compliance with healthcare regulations. Qui tam law suits brought by Medicaid fraud attorneys have recovered billions of dollars from companies committing health care fraud.
More than $30 billion has been recovered in Federal civil actions under the False Claims Act (“FCA”) since the statute which originated in the Civil War era, was amended in 1986 to provide enhanced rewards and protections for qui tam whistleblowers.
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On November 4, 2013, after nearly six years of litigation, Johnson & Johnson, the self-proclaimed “family company,” agreed to pay $149 million to the federal government, the states of California, Kentucky, Indiana, and Massachusetts, and the Commonwealth of Virginia, to settle Medicaid fraud claims under the False Claims Act. (
According to a press release issued by the Department of Justice, the federal government recovered over $3.8 billion from False Claims Act cases in 2013. Of the $3.8 billion, $2.9 billion resulted from whistleblower suits filed under the qui tam provisions of the Act. This is the fourth year in a row recoveries under the False Claims Act have topped $3 billion, and this year’s number is surpassed only by last year’s record-breaking recovery of nearly $5 billion. Although health care fraud continues to drive record recoveries, this year prosecutions of procurement and defense contracting fraud returned a record setting $890 million to the U.S. Treasury.