Justice Department Recovers $2.6 Billion in False Claims Act Health Care Fraud in FY13 By Tod Aronovitz | 02/13/14 | 0 Comment

Settlements and judgments from civil cases involving fraud against the government amounted to $3.8 billion in fiscal year 2013, our ARONOVITZ Blog reported on January 27 titled “Qui Tam Recoveries Account for $2.9 Billion of the $3.8 Billion False Claims Act Cases in FY13.”  According to the U.S. Department of Justice, the largest recoveries related to health care fraud, which reached $2.6 billion, marking the fourth straight year that the Department recovered more than $2 billion.

Continued success in this area can be attributed to the current administration’s high priority on fighting health care fraud, as well as the continued work of the interagency task force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT).  As a result, the department used the False Claims Act to recover $12.1 billion in federal health care dollars from January 2008 through FY13. Most of these recoveries involved fraud against Medicare and Medicaid.

Some of the largest health care fraud recoveries involved the pharmaceutical and medical device industries. Of the $2.6 billion recovered, $1.8 billion stemmed from alleged false claims for drugs and medical devices under federally insured health programs including Medicare, Medicaid, TRICARE (which provides benefits for military personnel and their families), veterans’ health care programs, and the Federal Employees Health Benefits Program. The department recovered an additional $443 million for state Medicaid programs.

In another victory under the False Claims Act, the Civil Division’s Consumer Protection Branch, along with U.S. Attorneys across the country, achieved 16 criminal convictions and obtained more than $1.3 billion in criminal fines, forfeitures and disgorgement under the Federal Food, Drug and Cosmetic Act (FDCA).

Significant health care fraud settlements in FY13 included:

  • Abbott Laboratories Inc.—$1.5 billion landmark settlement to resolve allegations of off-label marketing of its drug Depakote (more details).
  • Amgen Inc.— $762 million settlement, including $598.5 million in False Claims Act recoveries, to settle allegations that included its illegal promotion of its drug, Aranesp.
  • Ranbaxy USA Inc.—$505 million settlement to resolve allegations of false claims to federal and state health care programs for adulterated drugs distributed from its facilities in India.
  • Tuomey Healthcare System Inc.—$237 million judgment against the South Carolina-based company for violating the Stark Law and the False Claims Act. The Stark Law prohibits hospitals from making claims to Medicare for patients referred to the hospital by physicians who have a prohibited financial relationship with the hospital. Tuomey’s appeal is pending, but would be the largest judgment in the history of the Stark Law if the judgment is affirmed.
  • Steven J. Wasserman, M.D., paid $26.3 million to resolve allegations that the Florida dermatologist accepted illegal kickbacks from Tampa Pathology Laboratory, resulting in fraudulent claims to Medicare. The settlement is one of the largest with an individual in the history of the False Claims Act.

In addition to health care fraud, the Justice Department said that FY13 was a record year for procurement fraud matters. The department secured more than $887 million in settlements and judgments based on allegations of false claims and corruption involving government contracts.

In a statement, Assistant Attorney General for the Civil Division, Stuart F. Delery said, “The $3.8 billion in federal False Claims Act recoveries in fiscal year 2013, plus another $443 million in recoveries for state Medicaid programs, restores scarce taxpayer dollars to federal and state governments. The government’s success in these cases is also a strong deterrent to others who would misuse public funds, which means government programs designed to keep us safer, healthier and economically more prosperous, can do so without the corrosive effects of fraud and false claims.”

How to Report Miami Medicare Fraud

Healthcare or medical billing employees who have inside knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.