US HEALTH FRAUD STATISTICS

Governments produce more data and draw out of that data statistics to prove almost any theory that
can be thought of. In doing so results end up being more confusing than enlightening.

Fraud statistics since 1987 when the Amended False Claims Act went into effect required that the
Justice Department keep statistics on non-qui tam [Whistleblower cases”] filed by government
employed “insiders” and qui tam cases filed by citizens. Only the number of cases filed in both are
reported, the only thing reported are funds recovered and fees paid to relators which average 15%
before paying attorneys fees and taxes at the highest rate usually AMT rates. Unlike all other
cases amounts paid to relators and their counsel are not tax-free, and much more goes back to state
and federal government than 75%.

The Justice Department reports all case resolved, meaning settled as none go to court or face
double or triple damages as stated in the False Claims Act [FCA] , but doesn’t include Medicaid
which is a larger and faster growing than Medicare, but other sour. But these do not show any
Medicaid Recoveries as those in Medicaid as Medicare cases are only settled “out of court” evading
large court decisions, both CMS agencies recovering less than half a percent.

Medicaid cases are reported by TAF.org and Medicaid Fraud Control Units, reported separately in
annual summaries to HHS Inspector General. They are published in Justice Department press releases
and a few law firms. https://www.crowell.com/Practices/False-Claims-Act

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With only the number of cases and amounts settled for there is no way to determine exactly what was
“stolen from taxpayers”, as many thousands of cases weren’t filed or reported and are known only by
whistleblowers and relators stiffened by government agencies holding enforcement agencies back from
investigating cases and collecting the double and triple damages stealing from taxpayers which is
the only means to stop “Fraud in Government” discovered 40 years ago.

The recent case settled in November 2016 against Education Management Corporation is illustrative
of the “Fraud Problem” with amounts defrauded reported as $11 billion, while the amount of the
settlement was $95.5 million [1%]. This was shortly after Sally Quinn in charge of these cases said
they would start jailing people like these. But for the last 32 years in all of these qui tam
cases, filed by taxpayer citizens, not only has no one gone to jail, no one went to court.

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