tci Medicare Compliance & Reimbursement - 2018 Issue 16
Fraud And Abuse: Millions Made By Whistleblowers Willing to Take Down Fraudsters
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Article Overview
This article reviews recent healthcare fraud and abuse settlements and broader whistleblower activity tied to the False Claims Act. It discusses why qui tam cases matter to Medicare providers, compliance teams, and healthcare organizations facing federal and state scrutiny, and it summarizes the roles of DOJ actions, whistleblower recoveries, and advocacy groups that connect employees with counsel.
Why This Topic Matters
It helps healthcare organizations understand the enforcement environment around fraud and abuse, including why whistleblower complaints can trigger significant government investigations and settlements.
Article Sections
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Look at These 3 Qui Tam Suits
A review of three healthcare-related whistleblower matters involving federal settlements, compliance allegations, and government resolutions. The section focuses on the general types of conduct under scrutiny and the parties involved.
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Take a Look at These Statistics
A summary of recent False Claims Act and qui tam activity, including reported DOJ recovery trends and commentary on overall enforcement volume.
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Advocacy Groups Assist Whistleblowers
Discussion of organizations and outreach efforts that encourage whistleblowers to report suspected healthcare fraud and abuse, along with general compliance caution for providers.
What You Will Learn
- How whistleblower-driven enforcement affects healthcare organizations
- What recent fraud and abuse settlements signal about compliance risks
- How qui tam activity fits into False Claims Act enforcement trends
- What types of outreach help employees raise fraud concerns
Who Should Read This
- Healthcare compliance professionals
- Medical billing and coding staff
- Practice managers
- Hospital administrators
- Healthcare attorneys
- Fraud and abuse investigators
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