Historically, the U.S. Department of Justice has directed its efforts on combatting healthcare fraud by focusing on persons and companies who defraud or attempt to defraud federally funded healthcare programs, such as Medicare, Medicaid and TRICARE. To do so, the agency often relied on persons with knowledge of fraud to come forward and file a qui tam (whistleblower) lawsuit under the False Claims Act. The penalties under the FCA are steep, which is why it has been such a powerful tool to combat fraud.
Until just recently, though, fraud perpetrated against private health plans and insurance programs was not scrutinized as heavily as fraud involving federally funded healthcare programs.
Healthcare compliance programs, take notice.
Late this summer, the DOJ launched a three-year initiative entitled the Corporate Whistleblower Awards Pilot Program and updated their Evaluation of Corporate Compliance Program guidance. The program incentivizes individuals with information about corporate crime, including private healthcare fraud, to file a report with the DOJ conveying their first-hand knowledge in exchange for a potential monetary award.
Under this program, a whistleblower is someone who has (1) original, (2) relevant, (3) voluntary, and (4) truthful and complete information about corporate crime that (5) yields a successful asset forfeiture on behalf of the DOJ. “Corporate crime” includes federal healthcare offenses and crimes involving private healthcare benefit programs,...
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