The Department of Justice (DOJ) recouped more than $2.9 billion for the federal government from False Claims Act settlements and judgments during the 2024 fiscal year, with nearly $1.7 billion of the total related to healthcare.
Those tallies, announced Wednesday, included the highest-ever number of whistleblower cases in a single year—979 filings that contributed to $2.4 billion of the total and put more than $400 million into the whistleblowers’ pockets.
The top-line number outpaces fiscal 2023’s $2.7 billion, though the healthcare tally is slightly below that year’s over $1.8 billion related to healthcare. Fiscal 2021 remains the most lucrative year for False Claims settlements and judgments, with more than $5 billion.
“The False Claims Act and its whistleblower provisions remain a critical tool in protecting the public fisc and ensuring that taxpayer funds serve the purposes for which they were intended,” Principal Deputy Associate Attorney General Benjamin Mizer said in a statement.
False Claims Act recoveries help restore funds to federal healthcare programs including Medicare, Medicaid and TRICARE, the DOJ said. The $1.7 billion of healthcare recoveries only relates to federal losses, “but in many of these cases, the Department was instrumental in recovering additional amounts for state Medicaid programs,” it said.
The department’s announcement put a spotlight on settlements and recoveries related to companies and individuals who it said contributed to the country’s opioid epidemic, delivered unnecessary services and substandard care, took advantage of the Medicare Advantage program, paid out unlawful kickbacks for services and committed other types of healthcare fraud.
More than two dozen such examples were highlighted in the release.
Rite Aid Corporation and several of its affiliates, for instance, paid $7.5 million and agreed to provide an allowed, unsubordinated, general unsecured claim of $401.8 million in its bankruptcy case to resolve allegations it knowingly improperly dispensed prescriptions for controlled substances. Drug manufacturer Endo Health Solutions, which is currently in bankruptcy, also agreed to a $475.6 million claim over allegations that it aggressively marketed an opioid to high-volume prescribers.
Beyond opioids, Rite Aid and its subsidiaries were named a second time in the release for a $121 million settlement tied to inaccurately reporting drug rebates to Medicare.
Several healthcare providers were listed among the highlighted cases as well. Among the larger recoveries were $345 million from Community Health Network in a settlement related to services referred in violation of the Stark Law.
CVS Health’s primary care affiliate Oak Street Health paid the government $60 million to resolve allegations of kickback payments to third-party insurance agents in exchange for recruiting seniors to its clinics. Dialysis care company DaVita agreed to a $34.5 million payment over allegations of kickbacks to a competitor to induce referrals, while behavioral health care provider Acadia Healthcare Company paid $16.6 million over alleged billing for unnecessary services, improper discharges, and staffing shortcomings.
The DOJ also noted a $106.8 million settlement with Walgreens related to allegations of billing government programs for prescriptions that were processed and never picked up.
On the year’s Medicare Advantage investigations, the department added that it has continued to litigate “several other cases involving the Medicare Advantage program, including actions against UnitedHealth Group, Elevance Health (formerly Anthem), and the Kaiser Permanente consortium.”
The top-line number outpaces fiscal 2023’s $2.7 billion, though the healthcare tally is slightly below that year’s over $1.8 billion related to healthcare. Fiscal 2021 remains the most lucrative year for False Claims settlements and judgments, with more than $5 billion. (Year of the COVID-19 Pandemic)
"As we look ahead to the new administration, it’s noteworthy that the first Trump administration saw almost 370 more healthcare [False Claims Act] cases brought by relators than those filed during the Biden administration," he continued. "The first Trump administration also saw the highest number of healthcare-related [False Claims Act] cases brought in a single year by the Department of Justice. As people consider the potential enforcement climate for healthcare companies in 'Trump 2,' history may provide some interesting guidance."
There are many conflicting measures of the cost-effectiveness of Advantage Health Plans. The details are buried in the muck.
https://www.fiercehealthcare.com/ai-and-machine-learning/doj-secured-17b-healthcare-false-claims-settlements-judgments-during-fy24
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