Insiders aid in healthcare fraud cases

Whistle-blowers have helped authorities recover at least $9.3 billion from healthcare providers accused of defrauding states and the federal government since 1996, according to an analysis of Justice Department records.

The department intensified efforts in the 1990s to combat healthcare fraud by using private citizens with inside knowledge of wrongdoing. They now initiate more than 90% of the department’s lawsuits focusing on healthcare fraud.

Whistle-blowers start cases by filing a sealed complaint in federal court. The department investigates and can intervene, assuming the lead role in the lawsuit.

Whistle-blowers then get 15% to 25% of the amount recovered.

Of the $9.3 billion recovered between 1996 and 2005, whistle-blowers got more than $1 billion, analysts estimated, writing for the Annals of Internal Medicine. The analysts’ estimates are conservative.