The U.S. Department of Justice (DOJ) Office of Public Affairs recently released a report detailing the settlements and judgments from civil cases involving fraud and abuse claims obtained in fiscal year 2019. In total, the DOJ reports that it obtained more than $3 billion during FY 2019, the substantial majority of which ($2.6 billion) involved the healthcare industry. The report notes significant penalties involving the healthcare industry, including drug and device manufactures, healthcare providers, and individual owners and directors of healthcare companies.
The vast majority of the settlements and judgments during FY 2019 ($2.1 billion) arose from qui tam whistleblower lawsuits. The DOJ reported that 633 qui tam suits were filed in 2019, with an average of at least 12 new cases each week. During FY 2019, the Government paid out $265 million to the whistleblower individuals in these cases. The DOJ emphasized the “high priority this administration places on deterring fraud against the government” and noted the “tireless efforts” of DOJ investigators and litigators.
There were certain trends that the statistics reflected in terms of common allegations against healthcare providers. For example, there were multiple settlements involving allegations of improper marketing relationships, purported kickbacks being paid to providers, assertions of coding violations and upcoding, and allegations of false or misleading marketing.
Notably, the DOJ also highlighted several significant cases against, and settlements that were reached with, individuals.
Members of the healthcare industry should take careful note of the previous year’s settlements and judgments and assess their own internal compliance with healthcare fraud and abuse laws.