[author: Kasey Ashford]
DOJ Releases FY 2021 FCA Recoveries—On February 1, 2022, DOJ reported its second highest annual sum of False Claims Act (FCA) settlements and judgments, totaling more than $5.6 billion for FY 2021. The vast majority of FCA settlements in 2021—more than $5 billion—concerned matters in the healthcare industry and included recoveries from “drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians.” Some of the largest settlements in FY 2021 resulted from DOJ’s focus on the opioid epidemic.
In the press release, DOJ highlighted, among other things, FCA priorities concerning opioids, Medicare Part C, kickbacks, unnecessary medical services, and COVID-19 fraud. For example:
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Opioids: DOJ brought allegations against providers who were known to promote and prescribe drugs for unsafe, ineffective, and medically unnecessary uses, as well as allegations of kickbacks.
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Medicare Part C: DOJ identified Medicare Part C as an important priority for investigation and litigation. DOJ has focused on allegations involving plans and providers related to the manipulation of the risk adjustment process by submitting unsupported diagnoses.
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Kickbacks: DOJ pursued allegations of improper payments and other alleged “schemes involving the willful solicitation or payment of illegal remuneration to induce the purchase of a good or service paid for by a federal health care program.”
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Unnecessary Medical Services: Consistent with previous years, DOJ settled matters regarding allegations of providers billing federal programs for services that were medically unnecessary or for services not rendered as billed.
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COVID-19: Enforcement efforts regarding pandemic relief monies focused on matters “involving improper payments under the Paycheck Protection Program.” The DOJ will continue “to identify, monitor and investigate the misuse of critical pandemic relief monies.”
The government and qui tam relators filed 801 new cases in FY 2021. The full text of the DOJ Press Release is available here.
