DOJ's Whistle-Blower Recruitment Pays Off The Justice Department has recovered a record $2.5 billion in health care fraud over the past year — mostly with the help of drug company employees who blow the whistle to the federal government.


DOJ's Whistle-Blower Recruitment Pays Off

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Most of the talk about health care revolves around how much money the federal government is spending and how to limit it. But the Justice Department says it has actually recovered billions of dollars from health care fraud cases in recent years. That mostly came from employees who've blown the whistle on bad marketing and overbilling. There are hundreds more lawsuits in the pipeline, as NPR's Carrie Johnson reports.

CARRIE JOHNSON: The Justice Department says when it comes to fraud, the numbers don't lie. They're pointing to record settlements in cases against drug companies to show they're serious about cracking down on wasted government money.

Mr. TONY WEST (Justice Department): This administration has made health care fraud a priority.

JOHNSON: That's Tony West. He runs the Justice Department's civil division, which brings lawsuits using the False Claims Act. It's an old law from Civil War times that helps the federal government yank back money when it's been overcharged by contractors.

Mr. WEST: When you look at health care fraud and the recoveries that we've been able to obtain over the last two years, it's been about $4.6 billion. That's more money recovered in a two-year period than at any other time in history.

JOHNSON: The record settlements mostly came from Pfizer, Astra Zeneca and Novartis. Big drug makers accused of bad marketing practices or overbilling federal insurance programs. They've mostly been turned in by their own employees, who blow the whistle to the federal government.

Iowa Republican Charles Grassley helped expand the law two decades ago.

Senator CHARLES GRASSLEY (Republican, Iowa): The False Claims Act is one of the best tools we have against fraud in government. And, as the author of the upgrade of that legislation in 1986, quite frankly, I never anticipated it would be the really big tool that it's turned out to be.

JOHNSON: Grassley is a vocal critic of the government. But he says the Justice Department strategy is really working. With one exception: it takes too long.

Mr. PATRICK BURNS (Taxpayers Against Fraud): Right now, simply put, the U.S. government is being outgunned and out-manned by the people who are stealing from it.

JOHNSON: That's Patrick Burns. He's a spokesman for Taxpayers Against Fraud, a group that represents whistleblowers. He says the Obama administration is taking the issue seriously. But there aren't enough government resources.

BURNS: We have about a thousand cases that are backlogged right now. And we really - if we're really serious about hammering down on fraud, the most powerful message that we could send is to lawyer up at the U.S. Department of Justice.

JOHNSON: Experts who follow the issue say the settlements can never match up to the billions of dollars in profit that drug companies make before the Justice Department comes calling. Again, Burns.

Mr. BURNS: We probably cannot hit these companies up hard enough, financially, for them to change the economics of fraud. But what we can do, however, is start putting key executives in jail or making sure they can never work again.

JOHNSON: The Justice Department says it's working on that. Last year, it charged the former president of a major medical device company with making false statements to the Food and Drug Administration. And the former top lawyer at GlaxoSmithKline now faces as many as twenty years in prison for allegedly lying in another health care fraud investigation.

Carrie Johnson, NPR News, Washington.

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