DOJ to reward health care fraud whistleblowers
Here's what to tell them about a new Justice Department rewards effort.
Benefits managers, plan participants and even benefits advisors may have a new way to make money: Spot and report major cases of health care fraud against the employers’ health plans, the plan participants or the employers’ health insurers.
The U.S. Department of Justice has provided that revenue-generating opportunity through the new Corporate Whistleblower Awards Pilot Program.
The program is meant to inspire Americans to tell the department about types of fraud not commonly reported to existing whistleblower programs, such as the program that rewards people who help federal investigators identify major cases of Medicare fraud.
But the program explicitly offers rewards to individuals who provide relevant, useful information about cases of health care fraud involving “private or other non-public health care benefit programs, where the overwhelming majority of claims are submitted to private or other non-public health care benefits,” according to a batch of guidance describing the program.
Eligible reports could also involve “fraud against patients, investors and other non-governmental entities in the health care industry, where the overwhelming majority of the actual or intended loss was to patients, investors and other non-governmental entities,” officials said.
Related: Health care fraud: DOJ recovers $1.8B in false claims cases in 2023
Only individual people can qualify for the rewards; companies can’t.
Whistleblowers who provide information leading to assets being forfeited by a prosecuted entity could collect up to 30% of the first $100 million in net proceeds forfeited and 5% of any net assets forfeited between $100 million and $500 million.
The rules appear to cap net proceeds at $50 million.
The program is set to expire in three years.
The obstacles
You may have many boxes of fraudulent health care claims in your office.
But Mary Inman, a partner at Constantine Cannon and the head of its international whistleblower practice, warned in an email against assuming that lucrative whistleblowing opportunities will be common.
Just finding providers who order too many tests for patients may not be enough.
To be eligible to receive a whistleblower reward, you or other people who report fraud “will need to have exposed the type of health care fraud that would prompt DOJ to impose as a remedy a civil or criminal forfeiture of assets, which typically only happens in the more egregious cases,” Inman said.
Another challenge may be finding a health care crook who has enough money to be subject to a large asset forfeiture judgment.
“However, since the focus of DOJ’s new Corporate Whistleblower Award Program is on criminal activity, DOJ is more likely to be focused on punishment and deterrence than on a target’s ability to pay a fine, meaning that both smaller hospitals and group medical practices and big ones will be attractive targets for DOJ here,” Inman said.