The Unhealthy Truth: Healthcare Professionals Committing Fraud

In 2016 alone, the U.S. Department of Justice (“DOJ”) recovered over $4.7 billion in civil cases regarding fraud. . Of the $4.7 billion recovered by the Department of Justice for fraud claims in 2016, a whopping $2.5 billion was attributed to the healthcare industry. By this metric, more than half the fraud the DOJ catches arises from healthcare fraud!

Healthcare fraud comes in many different forms from throughout the sector: pharmaceutical companies, physicians, hospitals, outpatient clinics, and medical labs, just to name a few. Healthcare fraud can be defined differently in each circumstance, but some of the most common types of fraud are: unauthorized billing to Medicare and/or Medicaid, paying kickbacks for patient referrals, and knowingly misreporting drug prices.

The largest settlement bracket of 2016 came from drug manufacturers, which totaled $1.2 billion, or almost half of the total amount recovered in healthcare fraud cases during the year. Among the pharmaceutical companies who paid up were Wyeth and its acquirer Pfizer, Inc., who together paid $784.6 million to settle federal and state lawsuits that claimed Wyeth reported false drug prices and neglected to disclose hospital discounts.

Healthcare fraud, as we know, happens all too often. While the payouts for settlements per year may seem outrageous, we have a feeling that not everybody is being held accountable. Individuals (“whistleblowers”) with information of wrongdoing can potentially receive an incentive reward from the government for blowing the whistle on fraud. If you have any questions or need to report a case of fraud, Evans Law Firm, Inc. has immense experience with this type of law and we are happy to speak with you regarding any problems or questions you may have.

Contact Us

If you know of any healthcare fraud in Alameda County or in any California county, contact the Evans Law Firm elder attorneys at (415) 441-8669, or by email at info@evanslaw.com. Our attorneys have experience with complex financial contracts and large insurance companies. We can help guide your qui tam whistleblower case.