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Whistleblower program produces record recoveries in health care fraud

The Department of Justice has recovered a record $2.5 billion dollars this year in health fraud, largely resulting from the whistleblower program, which incentivizes employees with inside information on fraud to come forward to the government; in applicable cases, whistleblowers will receive a substantial reward.

This year’s recovery is up 25% from last year, totaling about $4.6 billion recovered in health fraud in the past two years. “That’s more money recovered in a two-year period than at any other time in history,” stated Tony West, assistant attorney general for the department’s civil division

NPR reports that the health fraud program has been so successful that the government has been looking to expand the incentives into other sectors, such as the developing SEC whistleblower program.

Among the cases that have contributed significantly to the year’s record recovery was a settlement with Pfizer in which the company paid $2.3 billion to resolve allegations of health care fraud. This case resulted from a whistleblower action and yielded $669 million in repayment to the federal government. The remainder was paid to states involved in the action and the whistleblower, who received at least $51.5 million.

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