Qui Tam (Whistleblower) Cases Continue to be the Driver.
Although we continue to see an increase in investigations based on random Medicare audits and internal Medicare reviews of your billing statistics, Whistleblower cases are still your biggest risk by a significant measure. Remember, the FCA allows one of your employees (or multiple employees) to file an allegation of fraud against your organization. If the government intervenes and is successful, the Whistleblower typically receives in the neighborhood of 20% of the total recovery. With most FCA cases having settlements involving millions of dollars, this is obviously a big incentive for disgruntled employees.
To that point, total recoveries from Whistleblower actions generated almost $1.7 billion in 2020. More than $309 million in Whistleblower share awards were paid in FY 2020. The full DOJ report can be found here.