DOJ recovers $1.8B from healthcare false claims cases: 4 things to know

The Department of Justice obtained more than $2.2 billion in fraud and false claims settlements and judgements in fiscal year 2020, and the bulk of those recoveries came from matters that involved the healthcare industry. 

Four things to know about the Justice Department's false claims recoveries

1. The Justice Department recovered more than $1.8 billion from healthcare false claims cases in fiscal 2020. In many of the cases, the healthcare companies agreed to or were ordered to pay additional amounts to state Medicaid programs. 

2. The largest recoveries from last fiscal year came from the drug industry. For example, Novartis paid more than $591 million to resolve claims it paid kickbacks to physicians to induce them to prescribe its drugs. 

3. The Justice Department pursued opioid-related fraud schemes in fiscal 2020. One of the largest recoveries was from Practice Fusion, a health information technology developer that accepted kickbacks from opioid manufacturer Purdue Pharma in exchange for implementing alerts in its EHR software that were designed to increase prescriptions for OxyContin. 

4. The Justice Department resolved several cases in which healthcare providers billed federal healthcare programs for medically unnecessary services or services that weren't provided. King of Prussia, Pa.-based Universal Health Services paid $117 million to resolve allegations that its psychiatric hospitals and behavioral treatment facilities submitted false claims for services that were not medically necessary. 

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