False Claims Act Recoveries Totaled $3 Billion in 2019, with Healthcare Leading the Way

The False Claims Act (FCA) remains one of the government’s most effective tools in fighting fraud, particularly in healthcare. According to the Department of Justice (DOJ), FCA settlement recoveries totaled $3 billion in 2019, demonstrating the continued strength of this key anti-fraud law.

As in previous years, the healthcare and pharmaceutical industries accounted for the largest portion of recoveries, with billions returned to federal healthcare programs such as Medicare, Medicaid, and TRICARE. These settlements reinforce the importance of whistleblowers and qui tam lawsuits, which help uncover fraud that would otherwise go undetected.

The Role of Whistleblowers in False Claims Act Recoveries

Many of these False Claims Act recoveries were the direct result of whistleblower lawsuits. Under the qui tam provisions of the False Claims Act, private individuals—known as relators—can file lawsuits on behalf of the government when they have evidence of fraud.

In 2019, more than 70% of FCA settlements and judgments originated from whistleblower cases, with relators receiving over $265 million in rewards for their role in exposing fraud. These whistleblower cases covered a wide range of fraudulent activities, including:

• Medicare and Medicaid billing fraud – Overcharging, upcoding, and unnecessary medical procedures
• Pharmaceutical fraud – Kickbacks, false drug marketing, and misbranding
• Defense and government contracting fraud – Overbilling, product substitution, and failure to meet contract specifications

The DOJ’s continued success in False Claims Act recoveries highlights the law’s effectiveness in holding corporations accountable for defrauding taxpayers.

Wilbanks & Gouinlock’s $31 Million Recovery Against Sutter Health

Among the significant FCA settlement cases in 2019, Wilbanks & Gouinlock (W&G) played a key role in securing a $31 million recovery against Sutter Health, a major California-based healthcare provider. This case contributed to the DOJ’s broader efforts in combating healthcare fraud and ensuring that taxpayer dollars are used appropriately in federal healthcare programs.

Key aspects of the case included:

• Allegations of false claims submitted to Medicare Advantage programs
• Improper risk adjustment practices leading to inflated reimbursement rates
• Collaboration between whistleblowers and the DOJ to expose fraudulent billing practices

This settlement underscores the importance of whistleblower-led investigations in False Claims Act enforcement. Read more details about this case here. For the full featured article in Law360 regarding this case, click here.

FCA Recoveries: A Look at 2019 by the Numbers

The DOJ’s 2019 False Claims Act statistics reveal key trends:

• Total recoveries: $3 billion
• Healthcare fraud recoveries: Over $2.6 billion (nearly 87% of the total)
• Whistleblower-initiated cases: 633 qui tam lawsuits filed
• Relator rewards: Over $265 million paid to whistleblowers

These numbers illustrate the FCA’s continued importance in protecting taxpayer funds and ensuring corporate accountability.

The Future of False Claims Act Enforcement

If you have evidence of private or government insurance fraud, contact our office for a free consultation:

• Fill out our consultation form by clicking here.
• Email us at info@wilbanksgouinlock.com.
• Call (404) 842-1075, ext. 123 or 122.

This article is for informational purposes only and should not be considered legal advice.