The U.S. Justice Department recovered more than $1.8 billion from healthcare-related False Claims Act settlements in 2020, marking the first time in more than a decade that they failed to clear $2 billion in returns, according to new federal data.

Healthcare-related cases made up more than 80% of the total $2.2 billion in False Claims Act cases. But the last fiscal year represents a 36% drop from fiscal 2019’s $2.6 billion in healthcare fraud settlements and judgments.

Whistleblowers filed more False Claims Act cases in 2020, with 672 qui tam cases compared to a previous high of 504 in 2013 and 2016. Whistleblower cases accounted for $1.6 billion of the fraud settlements overall.

The bulk of the healthcare fraud settlements involved pharmaceutical companies, according to the Justice Department. Novartis paid more than $591 million to settle one case alleging it paid doctors kickbacks for prescribing certain drugs, and another $148 million with Gilead Sciences over illegally paying patient copays for their products.

Universal Health Services (UHS) also made DOJ’s list in 2020, with a $117 million settlement over alleged false claims from its behavioral health hospitals and facilities.

Since the fiscal year ended on Sept. 30, the settlement totals don’t include a $2.8 billion civil settlement with Purdue Pharma for violating anti-kickback laws as a part of its involvement with the opioid epidemic.

The totals also don’t include an October announcement that federal prosecutors called the biggest fraud takedown in history. The enforcement at the time charged more than 340 individuals with submitting $6 billion in false claims, with nearly $4.5 billion of that involving telehealth.

Still, the Justice Department said those pending cases reflect the work their attorneys have done to address the opioid crisis and other department priorities.

“The continued success of the department’s False Claims Act enforcement efforts are a testament to the dedication of the civil servants who pursue these important cases as well as to the fortitude of whistleblowers who report fraud,” said Acting Assistant Attorney General Jeffrey Bossert Clark of the civil division, in a statement.


Source: Federal healthcare fraud settlements hit decade low in 2020

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