The U.S. Department of Justice announced on December 14, 2016 that the Department of Justice had recovered $19.3 billion in health care fraud claims from January 2009 to September 30, 2016, which was 57% of the health care fraud dollars recovered in the 30 years since the 1986 amendments to the False Claims Act. The recoveries involved false health care claims submitted to and paid by federally funded programs such as Medicare, Medicaid, and TRICARE.
The largest health care fraud recoveries in fiscal year 2016, which ended on September 30, 2016, came from the drug and medical device industry – $1.2 billion. False health care claims involving hospitals and outpatient clinics accounted for $360 million in health care fraud recoveries. Cases involving nursing homes and skilled nursing facilities accounted for more than $160 million in health care fraud settlements and judgments.
The largest recovery involving a drug manufacturer in fiscal year 2016 was received from Wyeth and Pfizer, Inc. in the amount of $784.6 million ($413.2 million to the federal government and $371.4 million to state Medicaid programs) to resolve federal and state claims that Wyeth knowingly reported false and fraudulent prices on two drugs used to treat acid reflux: Protonix Oral and Protonix IV. The U.S. alleged that Wyeth, before it was acquired by Pfizer, failed to report deep discounts available to hospitals, as required by the government to ensure that the Medicaid program enjoyed the same pricing benefits available to the company’s commercial customers.
The major U.S. hospital chain, Tenet Healthcare Corp., paid $244.2 million in fiscal year 2016 to resolve civil allegations that four of its hospitals engaged in a scheme to defraud the United States by paying kickbacks in return for patient referrals. Tenet paid an additional $123.7 million to state Medicaid programs, and two of its subsidiaries pleaded guilty to related charges and forfeited $145 million, bringing the total resolution to $513 million.
Millennium Health, formerly Millennium Laboratories, paid $260 million in fiscal year 2016 to settle allegations that it billed Medicare, Medicaid, and other federal health care programs for excessive and unnecessary urine drug and genetic testing and also that it gave free items to induce physicians to refer expensive and profitable lab tests to Millennium, in violation of the Anti-Kickback Statute and Stark Law. The settlement included $214.8 million in alleged false claims against federal programs, $26 million in alleged false claims against state Medicaid programs, and $19.2 million in related administrative claims.
Kindred Healthcare, Inc. and its subsidiaries, RehabCare Group Inc. and RehabCare Group East Inc., paid $125 million in fiscal year 2016 to resolve claims that it had induced skilled nursing homes to submit false claims to Medicare for rehabilitation services that were not reasonable, necessary, and skilled, or that weren’t provided at all.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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