Whistleblowers Play Major Role in Curbing Health Fraud

TUESDAY, Sept. 2 (HealthDay News) -- Between 1996 and 2005, federal prosecutions for health fraud initiated by whistleblowers with inside knowledge of allegedly illegal schemes resulted in the recovery of more than $9 billion in the United States, according to a report published in the Sept. 2 issue of the Annals of Internal Medicine.

Aaron S. Kesselheim, M.D., J.D., of Brigham and Women's Hospital in Boston, and a colleague obtained unsealed U.S. Department of Justice records of federal qui tam litigation that which was resolved between 1996 and 2005, and gathered additional information from public sources.

The researchers identified 379 cases that resulted in the recovery of $9.3 billion, including more than $1 billion that was paid to whistleblowers. They found that 75 percent of whistleblowers were employees of defendant organizations and that their ranks frequently included executives and physicians.

"Our data provide insight into the qui tam approach of targeting health care fraud, a mechanism that federal regulators have increasingly used to recoup losses and deter illegal activity," the authors conclude. "As government health budgets grow and the stresses on them mount, qui tam fraud and abuse litigation seems set to continue to play a pivotal role in helping state and federal regulators control inefficient spending."

Abstract
Full Text (subscription or payment may be required)