Healthcare accounted for bigger portion of 2018 DOJ false claims recoveries

Of the $2.8 billion the Department of Justice recovered from False Claims Act cases in 2018, $2.5 billion involved the healthcare industry, according to the department's year-end recap.

Last year the department recovered $3.7 billion in False Claims Act settlements and judgments, with $2.4 billion involving the healthcare industry.

The largest 2018 healthcare-related recoveries stem from the drug and medical device industry, including a $582 million federal settlement paid by AmerisourceBergen Corporation. The payment resolved allegations that the Chesterbrook, Pa.-based drug wholesaler illegally distributed adulterated and misbranded drugs, including syringes for cancer patients, and caused numerous false claims to be submitted to Medicaid for unapproved, defective or compromised new drugs.

Several substantial 2018 recoveries involve healthcare providers, including the $270 million payment from HealthCare Partners Holdings, doing business as DaVita Medical Holdings. The payment resolved False Claims Act liability for providing incorrect diagnosis codes that caused its Medicare Advantage Organizations to receive inflated Medicare payments.

Also worth noting is the case involving former Naples, Fla.-based hospital chain Health Management Associates, which paid over $216 million in 2018 to resolve civil allegations that it billed government healthcare programs for costly inpatient services that should have been billed as observation or outpatient services, paid illegal remuneration to physicians in return for patient referrals to HMA hospitals and inflated claims for emergency department facility fees.

This marks the ninth consecutive year that the DOJ's civil healthcare fraud settlements and judgments exceed $2 billion. Recoveries in the $2.5 billion total reflect only federal losses, but the DOJ was instrumental in recovering additional millions for state Medicaid programs in many cases.


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