Rebecca
Pifer@RebeccaMPifer
Jan. 10, 2020
Of more than $3
billion recovered by the federal government in fiscal year 2019 from fraud and
false claims, 87% involved the healthcare industry, the Department of
Justice announced Thursday.
It's the 10th
consecutive year the department has recouped more than $2 billion from False
Claims Act cases with HHS as a client. By comparison, the Department of Defense
accounted for more than $252,000 in recaptured funds, and other agencies just
$197,000.
The government
has strengthened its attempts to crack down on fraud over the past decade,
establishing groups like the Medicare Fraud Strike Force in 2007 and the Opioid
Fraud and Abuse Detection Unit in 2017. As healthcare fraud continues to rise
(the DOJ reported 247 new matters for potential investigation in 2000, 427 in
2010 and 505 last year), the government has recovered more taxpayer
dollars in stings, settlements and guilty verdicts.
Two of the
biggest recoveries came from opioid manufacturers amid the ongoing crackdown on
improper prescribing that gave rise to the opioid crisis, which has claimed
more than 200,000 lives since 1999, according to the CDC.
Insys
Therapeutics shelled out $195 million in June to settle claims it gave doctors
illegal kickbacks for prescribing its powerful opioid painkiller Subsys and
Reckitt Benckiser Group paid $1.4 billion in July over misleading marketing and
price fixing for its addiction treatment drug Suboxone in two of the largest
False Claims Act cases.
The latter was the
largest recovery in an opioid-related case in U.S. history.
In other major
cases for the federal government, drugmakers Actelion, Amgen, Astellas,
Alexion, Jazz, Lundbeck and US Worldmeds paid a combined $624 million to settle
allegations they illegally paid patient co-pays for their own drugs through
seemingly independent foundations as an end run around pricing limitations.
But pharmaceutical
companies weren't the only ones slapped on the wrist for such behavior, with
DOJ repossessing significant funds from a variety of parties in the fiscal year
ending Sept. 30.
Laboratory
Inform Diagnostics, for example, paid almost $64 million in January last year
to settle allegations it gave referring physicians kickbacks in the form of
subsidies for EHR systems and other tech services. One month later, EHR vendor
Greenway Health shelled out more than $57 million over misrepresenting its
product's capabilities and paying clients to talk it up to prospective customers.
Encompass
Health — the nation's largest operator of inpatient rehabs — settled up with
the DOJ to the tune of $48 million in June, resolving allegations it lied to
Medicare for higher reimbursements.
The $2.6
billion total price tag for healthcare recoveries only includes federal losses,
the DOJ said, noting it also recovered millions of dollars for state Medicaid
programs in 2019.
Since 1986,
when Congress strengthened the False Claims Act by allowing whistleblowers to
get up to 30% of the recovered funds, the DOJ has recouped more than $62
billion. Of that total, $42 billion has been from the healthcare industry.
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