The Hill had a fantastic article on the nearly $6 billion recovered in 2014 under the False Claims Act. The FCA allows the government to seek redress from individuals or entities that have in some way caused false statements to be used in the process of securing payment of government monies. The FCA is mostly known for its “qui tam” provisions that allow private citizens — commonly called whistleblowers — to bring suit in the name of the government, and to be paid a bounty from recovered funds. The FCA makes it unlawful to file a false claim or to “cause”one to be filed.  Once these suits are brought, the DOJ may intervene and pursue the case with or without the help of the whistleblower and counsel.

It turns out that of the $5.69 billion, $2.3 billion was recovered from healthcare providers, including the pharmaceutical industry, and $3.1 billion was recovered from the financial services industry including the big banks. This means that $5.4 billion was recovered from entities that had no direct procurement relationship with the federal government or the states.   Marketing drugs for purposes not approved by the Food and Drug Administration, and provision of healthcare that is not medically necessary are just some examples of conduct that cause the Medicare and Medicaid systems —and state and federal health plans — to pay out dollars that should not have been paid.  Most FCA recoveries have come from entities — particularly healthcare providers — where the accused culprit does not have a direct government procurement relationship.

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