There are a lot of reasons for the high number of healthcare-related False Claims Act cases. First of all, there is a ton of money spent on healthcare. The government spent more than $600 billion for Medicare alone in 2018 and the projections are for that figure to continue to rise, so obviously there’s a huge pool of money that’s involved.
The other important factor is that the contractual relationship between the government and the healthcare provider is different than it is in almost every other case built around a false claim. In these cases, the government pays for the service, but the government doesn’t actually receive the healthcare. Instead, an individual goes in and fills the prescription or is treated at the hospital for example.
So, strangely enough, that can make it an easier case to bring as a False Claims Act matter than many other types of cases. That contractual relationship can make it a more attractive case for lawyers to bring, and obviously the importance of the subject matter is another reason why people are always considering bringing healthcare cases.
How the Government Decides Whether to Take a Healthcare Fraud Case
It’s a little tricky to say what the government is looking for because there’s no specific rule book other than of course clear liability and damages. Generally, the government is looking for pretty much the same things that everybody is looking for in a case like this. They get many cases and they don’t have the resources to join the action in every single one of them. They want to know that the case is strong from the standpoint of being provable in terms of liability, and that the credibility of the information presented to them is real. They want to know that there is some real money at stake so that if they pursue it, then they have a chance of making a real recovery for the government.
Also, in healthcare, of course, there is the issue of patient harm. If there is patient harm, then understandably the government would likely treat the case with even more seriousness. Everybody wants to be able to prevent practices that create patient harm. After all, the government has an interest in the healthcare of its citizens and if the False Claims Act can facilitate better healthcare, then that’s a good thing.
In general, those are the things that the government looks for. These cases are complex and require a lot of analysis, though, so they’re usually analyzed on an individual basis to determine just how good they are.