- The Washington Times - Thursday, December 19, 2002

The Justice Department for the third year in a row recovered more than $1 billion in lawsuits and investigations of fraud cases against the federal government in the fiscal year ended Sept. 30, department officials said yesterday.
False Claims Act recoveries since the law was amended in 1986 have topped $10 billion, more than $6 billion of which was recovered under the so-called whistleblowers provisions of the act.
"The success of this statute is a tribute to the vision of its sponsors, Sen. Charles E. Grassley of Iowa and Rep. Howard L. Berman of California, as well as the thousands of private citizens who have reported fraud by filing suit under the act," said Assistant Attorney General Robert D. McCallum Jr., who heads the department's civil division.
In fiscal 2002, recoveries in civil fraud claims reached nearly $1.2 billion, a sum that includes investigations initiated by the government, as well as suits by whistleblowers, the officials said. Health care fraud accounted for the majority of recoveries, totaling more than $980 million.
Recoveries associated with suits brought by whistleblowers, including non-whistleblower claims resolved at the same time, accounted for almost $1.1 billion in settlements and judgments during the fiscal year, the officials said.
Among the department's largest recoveries in fiscal 2002 were:
$568 million from TAP Pharmaceuticals, accused of conspiring with doctors to bill Medicare for samples of the drug Lupron in violation of the Prescription Drug Marketing Act, paying kickbacks to providers to increase sales of Lupron and inflating its pricing of the drug to further a scheme in which TAP and its provider customers overcharged Medicare and Medicaid.
$87.3 million from PacifiCare Health Systems, accused of submitting false claims under contracts with the Office of Personnel Management to provide health care benefits to federal employees under the Federal Employees Health Benefits Program.
$76 million from General American Life Insurance Co., accused of improperly approving claims for federal Medicare funds and manipulating its quality-assurance data to conceal its failure to process claims properly. In addition to the monetary settlement, the firm agreed to stay out of the Medicare program for five years.
$73.3 million from the State of California and the County of Los Angeles, accused of billing Medicare for services provided to persons not eligible for Medicaid because they didn't meet the required standard of need.
$29 million from Lifemark Hospitals of Florida, accused of participating in a host of schemes, including submitting false Medicare claims for home health services, for hospital services not rendered, for services provided by unskilled, unlicensed or uncertified personnel, for services not ordered by a physician, and for services inadequately documented as required under the program.
$21.5 million from Union Oil Co. of California, accused of underpaying the Interior Department royalties owed for oil extracted from federal lands. It was the last of 16 major oil companies to settle claims in four related actions in which more than $430 million was recovered by the government, plus an additional $10 million on behalf of American Indians for losses suffered on tribal lands.
The whistleblower or "qui tam" provisions of the False Claims Act allow individuals, known as "relators," to file suit on behalf of the United States against those who have falsely or fraudulently claimed federal funds, including Medicare, Medicaid, disaster assistance and other benefits, subsidies, grants, loans and contract payments.
Persons who file qui tam suits can recover from 15 percent to 25 percent of any settlement or judgment reached in a case if the United States intervenes in the action, or up to 30 percent if they pursue it on their own. In fiscal 2002, relators recovered more than $160 million.

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