Key Takeaways from the 2022 False Claims Act Statistics

Although The Department of Justice (DOJ) had a downturn in terms of False Claims Act (FCA) recoveries in 2022, especially within the healthcare sector, the aggregate recovery still was in the billions with hundreds of millions given out as whistleblower rewards. The total FCA recoveries amounted to $2.207 billion, marking the lowest since 2008. Of this total, healthcare matters accounted for $1.761 billion, the lowest since 2009. Despite these figures, the healthcare industry remains a primary focus for the DOJ, constituting nearly 80% of all FCA recoveries and being subject to both criminal and civil enforcement actions.

Examining the DOJ’s FCA statistics reveals valuable insights, particularly concerning healthcare cases. Notably, alongside whistleblower-initiated “qui tam” cases, the DOJ continues to bring forth more “direct file” healthcare cases. In 2022, the DOJ initiated 93 such cases, ranking as the 4th best year since the FCA amendment in 1986. In contrast, whistleblower-filed health care-related qui tam cases numbered 371, representing the lowest count since 2009. However, whistleblower recoveries in health care qui tam cases witnessed a significant increase.

Remarkably, 2022 proved to be the most successful year for whistleblowers pursuing health care cases in which the DOJ did not intervene, commonly referred to as “declined” matters. Whistleblowers in these cases collectively recovered $1.013 billion, surpassing the $641 million recovered in cases where the DOJ intervened. This achievement also extended to the relator’s share, with whistleblowers receiving a total of $295 million in whistleblower awards, setting a new record. This trend underscores the dedication of whistleblower counsel in developing robust health care fraud cases that they are willing to pursue even without DOJ involvement.

Focusing on the cases themselves, FCA health care recoveries in 2022 encompassed a wide range of health care providers and claims. Noteworthy cases included allegations of unnecessary services and substandard care in nursing homes, a hospital system, a hospice provider, a large physician practice, and a pharmacy.  Some of the best whistleblower law firms, like Brown, LLC contributed to the recovery, with roughly $30 million in FCA recoveries in 2022.

“These statistics underscore the evolving landscape of healthcare enforcement, where the False Claims Act plays a pivotal role. The continued focus on healthcare cases by the DOJ, coupled with the rise of whistleblower-initiated actions, signals a growing emphasis on accountability and transparency within the industry. Insiders who expose fraud stand to gain quite a bit if they do it the right way, and more importantly, help keep companies accountable and help avoid patient harm.” Said Jason T. Brown, head of the whistleblower law firm, Brown, LLC.

The most substantial settlement in 2022 involved a pharmaceutical company agreeing to pay $843.8 million to resolve kickback-related allegations which violates the Anti-Kickback Statute (AKS) a component of the False Claims Act. Another case featured a pharmaceutical manufacturer paying $260 million to settle claims of Medicaid fraud and abuse.

Given these factors, it is foreseeable that the prosecution and enforcement of the FCA, driven by both the DOJ and whistleblowers, will continue to grow and exert a significant impact on the healthcare industry and will still in the billions each year for some time to come