Feb. 3, 2025
COSMOS Compliance Universe
Nelson Mullins attorneys Jillian Willis and Jordan Brunson authored a new article published in the February edition of COSMOS Compliance Universe. In the article, Willis and Brunson compare the new U.S. Department of Justice Criminal Whistleblower Program to the traditional False Claims Act (FCA). They highlight key differences such as the scope of fraud covered, the types of offenses that can be reported, and the reward structures, noting that the Criminal Whistleblower Program extends beyond government healthcare fraud (like Medicare and Medicaid) to include other private health insurance and nonpublic health benefit programs. They also address differences in eligibility criteria and procedural requirements for whistleblowers in each program:
The U.S. Department of Justice’s (DOJ) Criminal Division launched its Corporate Whistleblower Awards Pilot Program (“Criminal Whistleblower Program”) in August of 2024 to encourage tips for various types of fraud, including fraud on private health insurance programs. This program purportedly “fills gaps,” covering conduct not included in other whistleblower programs like the False Claims Act (FCA). Healthcare compliance teams must now consider this new incentive for company employees to report “federal health care offenses and related crimes involving private or other nonpublic health care benefit programs.”
Healthcare compliance programs around the country are likely already familiar with the FCA, which rewards relators who report fraud against government healthcare payers like Medicare and Medicaid. The FCA itself imposes treble damages and penalties against any person or organization who knowingly submits, or causes to submit, false claims to the government. A relator who successfully prevails in a qui tam suit on behalf of the government receives a percentage of the recovery. While the FCA can provide a framework for considering how the criminal corporate whistleblower may operate, there are important distinctions.
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