Whistleblower-Initiated Enforcement Actions Against Health Care Fraud and Abuse in the United States, 1996 to 2005

Annals of Internal Medicine, Vol. 149, No. 5, pp. 342-349, September 2008

Posted: 22 Nov 2009

See all articles by Aaron S. Kesselheim

Aaron S. Kesselheim

Brigham and Women's Hospital/Harvard Medical School

David M. Studdert

University of Melbourne - Faculty of Law & Faculty of Medicine, Dentistry and Health Sciences

Date Written: September 2, 2008

Abstract

Federal regulators have aggressively prosecuted health care fraud since the early 1990s, leading to billions of dollars in financial recoveries. Nearly all major cases today are qui tam actions, involving whistleblowers with inside knowledge of the allegedly illegal schemes. This article documents the outcomes of major enforcement actions and describe the schemes, defendants, and whistleblowers involved. The authors obtained an inventory of unsealed federal qui tam litigation targeting health care fraud that was resolved between 1996 and 2005 from the U.S. Department of Justice and gathered further information from publicly available sources. Among 379 cases, $9.3 billion was recovered, with more than $1.0 billion paid to whistleblowers. Case frequency peaked in 2001, but annual recoveries increased sharply from 2002 to 2005. Whistleblowers were frequently executives or physicians, and 75% were employees of defendant organizations. The 13 (4%) cases against pharmaceutical companies accounted for $3.6 billion (39%) of total recoveries. This study illuminates the scope and characteristics of qui tam fraud litigation and the whistleblowers who animate this important tool for addressing waste in the health care sector.

Keywords: Health care fraud, qui tam, whistleblowers, pharmaceutical industry

Suggested Citation

Kesselheim, Aaron S. and Studdert, David M., Whistleblower-Initiated Enforcement Actions Against Health Care Fraud and Abuse in the United States, 1996 to 2005 (September 2, 2008). Annals of Internal Medicine, Vol. 149, No. 5, pp. 342-349, September 2008, Available at SSRN: https://ssrn.com/abstract=1510846

Aaron S. Kesselheim (Contact Author)

Brigham and Women's Hospital/Harvard Medical School ( email )

1620 Tremont St
Suite 3030
Boston, MA 02120
United States
617-278-0930 (Phone)
617-232-8602 (Fax)

HOME PAGE: http://www.PORTALresearch.org

David M. Studdert

University of Melbourne - Faculty of Law & Faculty of Medicine, Dentistry and Health Sciences ( email )

185 Pelham Street
Carlton, Victoria 3053
Australia

Do you have negative results from your research you’d like to share?

Paper statistics

Abstract Views
622
PlumX Metrics