False Claims Act Summary for 2019 – Healthcare Fraud

The US Justice Department announced on January 9, 2020, that the agency had recovered more than $3 billion in fiscal year 2019 through cases brought through the False Claims Act. The use of a stronger False Claims Act has led to more than $62 billion in recoveries by the US DOJ since 1986. The qui tam whistleblower provisions of the law led to $2.1 billion in recoveries and $265 million in payouts to whistleblowers who exposed fraudulent claims to the government.

Healthcare Fraud

A large bulk of the 2019 recoveries were for health care fraud. Health care fraud generally involves the submitting of bills to Medicare, Medicaid, and TRICARE, that the submitter knows to be false. Healthcare fraud puts patient safety at risk, increases the amount the public pays for health care, and affects those medical professionals who play by the rules.

Two of the biggest recoveries last year were against opioid manufacturers. One case was resolved for nearly $200 million against a manufacturer who was alleged to have paid kickbacks to doctors in the form of sham speaker events and jobs for friends and relative of prescribers – in order to induce doctors and nurses to prescribe the company’s medications. The allegations also included charges the company encouraged doctors to lie to insurers and to prescribe the medication when it wasn’t needed.

Another opioid manufacturer, Reckitt Benckiser Group PLC paid $1.4 billion for improper marketing of the drug Suboxone. The allegations included charges the company and its subsidiaries used “false and misleading claims that Suboxone was less susceptible to diversion, abuse, and accidental pediatric exposure than other buprenorphine products.”

Avanir Pharmaceuticals paid more than $95 million on charges of kickbacks to healthcare providers to induce the doctors who worked with or in long term care facilities – to prescribe “Neudexta for behaviors commonly associated with dementia patients, which is not an approved use of the drug.”

Other health care fraud issues included:

  • The improper funding of co-payments for Medicare patients. Copays were enacted by Congress to serve as a check on health care costs.
  • Kickbacks to referring doctors “in the form of subsidies for electronic health records (EHR) systems and free or discounted technology consulting services.”
  • Providing false information to Medicare to earn a higher rate of reimbursement

If you know of any health care fraud, you may be eligible to file a whistleblower claim. In whistleblower cases, if the information leads to a recovery, the whistleblower may be entitled to a strong percentage of the amount recovered. The California Law Offices of Stephen A. Danz and Associates has the experience and resources to help you pursue a qui tam/whistleblower case. pursue your claim. For help now, call us at 877-789-9707 or use our online contact form to schedule an appointment.