The False Claims Act is not limited to healthcare fraud. Many other types of fraud, such as fraud by military contractors making weapons systems, have led to large recoveries for whistleblowers and the government. However, several types of healthcare fraud, where government programs such as Medicare and Medicaid have been fraudulently overcharged, have also led to large recoveries by whistleblowers.
The three largest healthcare programs that the federal government funds are the
Medicare Program, the
Medicaid Program (partially funded), and the
TRICARE Program. Below are some examples of the types of healthcare fraud against the government that can occur.
In December 2000, the government recovered over $731 million dollars from HCA, the Healthcare Company (formerly named "Columbia HCA"), under the False Claims Act. The case involved numerous fraudulent practices including billing government programs for services not ordered by doctors, listing patient problems as more serious than they really were to get greater payments from the government, and billing the government for costs which were not reimbursable under the law. In 2003, the same family of companies, operating under the name "HCA, Inc.," settled another False Claims Act suit for $631 million related to fraudulent cost reporting and kickback schemes to doctors.
In October 2001, TAP Pharmaceutical Products Inc. agreed to pay $875 million to resolve criminal charges and civil liabilities in connection with fraudulent drug pricing and marketing of Lupron, a drug sold for the treatment of prostate cancer. Of this amount, $559,483,560 was recovered under the False Claims Act. In addition, TAP pled guilty to a conspiracy to violate the Prescription Drug Marketing Act and paid a $290 million criminal fine, the largest criminal fine ever in a health care fraud prosecution. Under the Lupron scheme, TAP gave doctors kickbacks by providing free samples with the knowledge that the physicians would bill Medicare and Medicaid $500 per dose. At the time the Lupron fraud was discovered, Lupron accounted for 10% of the money spent on prescription drugs under Medicare Part-A.
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