Can healthcare fraud serve as a basis for whistleblower lawsuits brought under the False Claims Act?

In fiscal year 2023, more than $1.8 billion of the $2.68 billion recovered under the False Claim Act came from defendants in the healthcare industry.  This figure made healthcare fraud the leading basis for False Claims Act settlements and judgments. Healthcare fraud recoveries protect some of the most important programs funded by the federal fisc, including Medicare, Medicaid, TRICARE, and the VA.  Beyond returning money to taxpayers, False Claims Act resolutions in the healthcare space also deter bad actors from putting profits over patients.

Healthcare fraud matters brought under the False Claims Act by whistleblowers and DOJ cover a variety of misconduct. Cases brought in fiscal year 2023 focused on a number of subjects, including:

• Medicare Part C, or the Medicare Advantage program
• Medical unnecessary services and substandard care
• Issues relating to the opioid epidemic
• Unlawful kickbacks solicited or paid to induce the purchase of goods or services covered by a federal healthcare program

Healthcare fraud remains an important enforcement priority for DOJ.  Policing misconduct in this arena is necessary to preserve taxpayer-funded government healthcare programs and protect patients from potential harm.