Qui Tam Whistleblower Lawsuits Expose Fraud, Net Billions in Recoveries

Recently released Department of Justice information confirms that whistleblower provisions in the False Claims Act (FCA) remain a powerful tool to reign in fraud, waste and abuse in government programs.

2024 False Claims Act Highlights:

• FCA lawsuits resulted in $2.9 billion in fines and recovered funds in fiscal year 2024. Of the total, $2.4 billion came from qui tam whistleblower actions.
• There were 558 settlements and judgments in 2024, marking the second-highest total behind 2023’s record of 566.
• Whistleblowers filed 979 qui tam lawsuits, the highest ever in a single year.

What is the False Claims Act?

The False Claims Act’s qui tam provision empowers individuals, known as “relators,” to file lawsuits on behalf of the government against businesses that have defrauded it. Essentially, it allows whistleblowers with inside knowledge of fraudulent activity, like overbilling or submitting false claims for government contracts, to step forward. The relator in these cases is uniquely able to expose wrongdoing in “qui tam” lawsuits that might otherwise remain hidden, and in return, they can receive a portion of the government’s recovery. The arrangement incentivizes individuals to report fraud, providing a crucial mechanism for uncovering and prosecuting those who attempt to cheat taxpayers, and ultimately, protects the integrity of public funds.

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Fraud within government-funded healthcare programs — including Medicare, Medicaid and TRICARE — remained the primary source of False Claims Act settlements and judgments, including:

• Opioid-Related Claims. The Justice Department targeted entities contributing to the opioid crisis, resulting in some of the largest monetary settlements of 2024. Endo Health Solutions reached a $475.6 million settlement to resolve claims that it aggressively marketed Opana ER to high-risk prescribers. Rite Aid Corporation and affiliates reached a combined $409.3 million settlement of claims related to dispensing unlawful opioid prescriptions.
• Unnecessary Services and Substandard Care. Strauss Ventures LLC, doing business as The Grand Health Care System, paid $21.3 million for inflating therapy services and enforcing quotas that led to excessive patient stays. Acadia Healthcare Company Inc. reached a $16.6 million settlement over allegations of unnecessary inpatient behavioral health services, poor discharge practices, and inadequate staffing that led to patient harm. Fountain Health Services LLC owner Dr. Daniel Hurt and his companies paid over $27 million to resolve claims regarding Medicare billing for unnecessary cancer genomic tests.
• Kickbacks and Stark Law Violations. Community Health Network Inc. paid $345 million in a settlement regarding compensation for physicians above fair market value to secure referrals. DaVita Inc. settled for $34.5 million over improper referral incentives. CVS subsidiary Oak Street Health paid $60 million to resolve allegations related to kickbacks to insurance agents to steer seniors to its clinics. Other notable settlements involved Prema Thekkek ($45.6 million), RDx Bioscience ($10.3 million), and Innovasis ($12 million) for various kickback schemes.
• Other Healthcare Fraud. Rite Aid Corporation and its subsidiaries paid a combined $121 million to resolve claims over misreported drug rebates. Walgreens paid $106.8 million for billing prescriptions never picked up.

How Do We Fight Fraud Against the Government? 

Seek justice on behalf of taxpayers with the help of our experienced attorneys. Our Dallas, Texas, whistleblower team has battled corporate giants for 20 years, aggressively fighting to hold corporations, individuals, and other entities accountable for fraud committed against the government. If you believe you have a whistleblower case, we can help.