Whistle-Blower Lawsuits Helped Recover At Least $9.3B From Health Care Providers Accused of Defrauding States, Federal Government, Analysis Finds

Whistle-blowers have helped the Department of Justice recover at least $9.3 billion from health care providers and pharmaceutical companies that allegedly defrauded states and the federal government, according to a report published recently in the Annals of Internal Medicine, the AP/San Francisco Chronicle reports.

DOJ in the 1990s began to use whistle-blowers in efforts to fight health care fraud, and whistle-blowers currently initiate 90% of such cases for the department. In such cases, whistle-blowers file sealed complaints in federal court, and DOJ investigates the allegations and can join the lawsuits. Whistle-blowers receive between 15% and 25% of the amount recovered by DOJ in such cases.

For the report, Aaron Kesselheim of Brigham and Women's Hospital and David Studdert of the University of Melbourne reviewed DOJ records from 379 health care fraud cases between 1996 and 2005, although they had information for only three-fourths of those cases. According to the report, the number of health care fraud cases has decreased in recent years, but the amount that DOJ recovered in those cases increased.

Kesselheim and Studdert cited the need to conduct additional research on whistle-blower lawsuits to determine which types of cases are more likely to lead to recoveries to allow DOJ to expedite such cases (Freking, AP/San Francisco Chronicle, 9/1).