Department of Justice Recovers $2.6 Billion from Healthcare Fraud Cases in FY 2013

Friday, January 24, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

According to a press release posted on December 20, 2013, the Department of Justice (DOJ) announced that it secured $2.6 billion in settlements and judgments from healthcare fraud in fiscal year 2013. That amount makes 2013 the fourth consecutive year that the DOJ has recovered more than $2 billion in healthcare fraud cases. Recoveries from healthcare fraud made up a majority of total recoveries under the False Claims Act. To read the entire press release from the DOJ, click here.


Overview of Healthcare Fraud in 2013.

According to the DOJ, of the $2.6 billion in healthcare fraud recoveries, some of the largest recoveries involved allegations of fraud and false claims in the pharmaceutical and medical device industries.

Many of the settlements involved allegations relating to the manufacture and distribution of adulterated drugs. For example, generic drug maker Ranbaxy USA Inc., settled allegations of false claims for adulterated drugs distributed from its facilities in India and paid $500 million in criminal and civil fines. To read more on this topic, click here to view my previous blog.

In another big healthcare fraud case from 2013, the DOJ obtained a $237 million judgment against Tuomey Healthcare System Inc., for violating the Stark Law and the False Claims Act. Currently Tuomey’s appeal of the judgment is pending. To read more on the background of this case, click here for a previous blog.


Recoveries from Whistleblower Lawsuits.

The DOJ also announced that $2.9 billion related to lawsuits filed under the qui tam provisions of the False Claims Act was recovered in 2013. The number of total qui tam lawsuits filed in 2013 (not specific to healthcare cases) rose to 752, which is 100 more than the record set in the previous year.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation. To learn more on whistleblower cases, read my two-part blog. Click here for part one, and click here for part two.


Example of Whistleblower Cases in Florida.

In September 2013, a group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5 million. The government alleged that the defendants regularly billed for radiation oncology services that were not supervised by a physician, as required by Medicare, Medicaid and TRICARE. It was also alleged that the defendants billed for services never rendered, double billed for the same services and misrepresented the level of service provided to increase their reimbursements. To read more, click here.

On October 28, 2013, a Florida federal judge approved a $3 million settlement in a False Claims Act lawsuit alleging Hospice of the Comforter Inc., defrauded Medicare. The lawsuit was filed by the former vice president of finance for the hospice. The case alleged Hospice of the Comforter submitted false claims to Medicare for hospice care patients who were not terminally ill. Click here to read my previous blog.

It is obvious that the government has become more aggressive in anti-fraud and recovery efforts. Now that there is money successfully being collected, you can expect their efforts to become more aggressive. Be sure to check our blogs regularly for more on healthcare fraud.


Contact Health Law Attorneys Experienced with Healthcare Fraud Cases.

Attorneys with The Health Law Firm are experienced in healthcare fraud cases. They represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program. We also handle Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.


Source:

Department of Justice. “Justice Department Recovers $3.8 Billion from False Claims Act Cases in Fiscal Year 2013.” Department of Justice. (December 20, 2013). From: http://www.justice.gov/opa/pr/2013/December/13-civ-1352.html


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


Tag Words: qui tam, qui tam lawsuits, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection, Florida whistleblower attorney, Florida whistleblower lawyer, False Claims Act, settlement agreement, defense attorney, defense lawyer, Department of Justice (DOJ), false billing, false claims, legal representation, medicare, medicare audit, Medicare false claims, Medicare fraud, Medicaid, Medicaid audit, Medicaid false claims, The Health Law Firm

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.
1/24/2014

Like this blog? Add your public comments:

Items in bold indicate required information.