Medicare program

In spite of the FCA’s frequent use in the Medicare arena, no research has ever quantified the extent of the FCA court data that exist. Although the U. S. Department of Justice (DOJ) records data on the number of FCA whistleblower complaints that are filed against any program within HHS, these data are too limited to directly inform this study. The DOJ data do not systematically track which specific alleged billing activities each FCA complaint entails or which specific HHS program each complaint pertains to (“Fraud Statistics - Health & Human Services,” 2006;

Stephens, 2007). Similarly, the DOJ data start in 1986, so they do not demonstrate the true growth in all types of FCA complaints over the full life of the Medicare program (“Fraud Statistics - Health & Human Services,” 2006). Likewise, the OIG maintains a database of ongoing Corporate Integrity Agreements (CIA)—or agreements between a provider and the government “as part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes” (OIG, 2007a).

However, these data only represent cases that settled, and they also only document the CIAs that are currently in effect rather than all CIAs that were developed over the life of the Medicare program (OIG, 2007b). Additionally, the CIA data do not typically provide adequate evidence to indicate which specific activities a provider was accused of, or whether the accusation was pursued under the FCA or any other law such as the Civil Monetary Penalties Law. Lastly, the CIA data do not clarify whether the provider was specifically involved in the Medicare program or only participated in other federal health programs, such as Medicaid (OIG, 2007a, 2007b). 

This study takes a step towards filling the void of consolidated empirical evidence on this issue by creating a unique data set that enables the assessment of all of the alleged fraudulent or improper provider activities that have surfaced in every available civil FCA court opinion pertaining to Medicare providers over the life of the Medicare program.