Information from a Tysons Corner Healthcare & Medicare Fraud Attorney

“The current administration has made the recovery of healthcare fraud dollars a top priority,” explains Downey.  The federal government has recovered some $16.5 billion in fraud dollars post January 2009 through the end of 2015.  This is more than one-half of all healthcare fraud dollars obtained since the amendments to the False Claims Act were enacted in 1986.  In 1986, Senator Charles Grassley and Representative Howard Berman led efforts to amend the False Claims Act to encourage whistleblowers to come forward with allegations of fraud.  In 2009, Senator Patrick J. Leahy, along with Senator Grassley and Representative Berman, also championed the Fraud Enforcement and Recovery Act of 2009, which made additional improvements to the False Claims Act and other fraud statutes. “Fraud Enforcement and Recovery Act of 2009” And in 2010, the passage of the Affordable Care Act provided additional protections for whistleblowers and strengthened the provisions of the federal health care Anti-Kickback Statute. “Federal Anti-Kickback Statute

The department’s aggressive pursuit of health care fraud also deters others who might otherwise attempt to defraud government programs for their own gain.   In 2009, the Attorney General and the Secretary of the Department of Health and Human Services announced the creation of an interagency task force called the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to increase coordination and optimize criminal and civil enforcement.

Two of the largest health care recoveries this past year were from DaVita Healthcare Partners, Inc., the leading provider of dialysis services in the United States.  DaVita paid some $450 million to resolve claims that it knowingly generated unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients for costs that could have been avoided.  DaVita also paid an additional $350 million to settle allegations that it paid kickbacks to physicians to induce patient referrals to its clinics.

Hospitals paid out some $330 million in settlements and judgments this past year.  A nurse and a healthcare consultant filed a qui tam suit against hundreds of hospitals that were allegedly implanting cardiac devices in Medicare patients contrary to Medicare criteria.  The government settled with nearly 500 of these hospitals for a total of $250 million, including $216 million recovered in the last year.  For more information about these cases click here.

Several settlements involved violations of the Stark Law. “Stark Law” The Stark Statute prohibits certain financial relationships between hospitals and doctors that could improperly influence patient referrals.  Services provided in violation of the Stark Statute are not reimbursable by Medicare or Medicaid.  Hospitals settling false claims involving Stark violations include Adventist Health System for $115 million, an organization that operates hospitals and other health care facilities in 10 states; North Broward  Hospital District for $69.5 million, a special taxing district of Florida that operates hospitals and other health care facilities in Broward County, Florida; and Georgia hospital system Columbus Regional Healthcare System and Dr. Andrew Pippas for $25 million plus contingent payments up to an additional $10 million.  The Adventist settlement also involved allegations of miscoding claims to obtain higher reimbursements for services than allowed by Medicare and Medicaid.

Pharmaceutical claims against drug companies accounted for $96 million in recoveries.  Daiichi Sankyo Inc., an international drug company with its headquarters in New Jersey, paid some $39 million to resolve allegations of false claims involving government programs. The government also alleged that Daiichi paid kickbacks to physicians to induce them to prescribe Daiichi drugs, including Benicar, Azor and Tribenzor.

The United States settled false claims allegations with AstraZeneca for some $26 million and Cephalon for $4.3 million.  Allegations were based on claims that these companies underpaid rebates under the Medicaid Rebate Program.  These companies also paid an additional $23 million to state Medicaid programs for their losses.  In another settlement, PharMerica Corp., the nation’s second largest nursing home pharmacy, agreed to pay the United States $9.25 million to resolve allegations that it obtained kickbacks from Abbott Laboratories in exchange for promoting the drug Depakote for nursing home patients.  PharMerica is headquartered in Louisville, Kentucky.