2018 OIG False Claims Act Settlements
In 2018, the total recovery from False Claims Act (FCA) judgements and settlements was a massive $2.8 Billion! Interestingly, while this represented the lowest recovery amount since 2009, the downward trend was primarily caused by a decline in recoveries from non-healthcare related cases. Healthcare related cases generated $2.5B in recoveries in 2018, which is actually up from $2.4B in 2017.
These large financial settlements and fines continue to provide strong incentive for "relators", internal whistleblowers, to report FCA cases to the Department of Justice. $1.9 of the $2.5 billion in healthcare related recoveries are from qui tam whistleblower cases - which in turn generated $266 million in relator share awards.
With these sorts of financial incentives in play, healthcare organizations need to make sure they are doing everything they can to ensure compliance with government regulations, especially when it comes to physician contracting programs. Time and again, organizations operating in good faith and doing their best to maintain a culture of compliance with documented policies and procedures not only ward off more potential compliance issues in the first place, but are shown leniency from the OIG if any violations do occur.
Furthermore, executives at these organizations can be held personally accountable -- the OIG has made it clear that individuals responsible for wrongdoing will continue to be a top priority in every corporate investigationg. A corporate settlement resolution will not defaultly protect individuals from their own criminal liability. In fact, companies must identify all wrongdoing by senior officials to receive credit for cooperating with Department of Justice investigators.