OIG Doubles Healthcare Fraud Recoveries in 2019

If it seemed like the government was cracking down extra hard on healthcare fraud this year, it was. According to a recently released report from the Office of Inspector General (OIG), the watchdog agency expects to recover $5.9 billion as a result of healthcare fraud investigations in 2019. That’s nearly double the amount it recovered in fiscal 2018, when it totaled $2.91 billion.

More than $819 million is expected to be recovered from audits, while $5.04 billion is expected to be recovered as a result of investigations into criminal actions, civil and administrative settlements, civil judgments and administrative actions by the OIG.

There were 809 criminal actions filed against individuals and organizations and another 695 civil actions, which included false claims and unjust enrichment lawsuits, as well as civil monetary penalty settlements and administrative recoveries related to self-disclosure.

In addition to monetary penalties, 2,640 individuals and entities were excluded from taking part in federal healthcare programs such as Medicare and Medicaid.

While many of the investigations focused on the usual types of healthcare fraud, the OIG noted that its work included a “first-of-its kind investigation†of a major genetic testing fraud scheme that resulted in a $42.6 million settlement. In that case, 35 defendants, including nine doctors associated with dozens of telemedicine companies and labs were charged.

Telehealth fraud has become another big target of the government’s investigators. In April 2019, the OIG announced they had dismantled a healthcare fraud scheme involving more than $1.2 billion in losses. The scheme involved the prescribing of unnecessary orthotic braces. Charges were filed against 24 defendants in 17 federal districts.

Pharmaceutical companies also have been ripe for fraud. Reckitt Benckiser Group PLC and Reckitt Benckiser LLC (collectively “RB Group”) entered into a $700 million civil FCA settlement in connection with the marketing and promotion of the opioid addiction treatment drug Suboxone. 

Three pharmaceutical companies agreed to pay a total of $122.6 million to resolve allegations that they each violated the FCA by illegally paying the Medicare or Civilian Health and Medical Program (ChampVA) copayments for their own products, through purportedly independent 501(c)3 foundations that the companies used as mere conduits for unlawful payments to patients.

Other cases included:

The conviction of two Florida residents in the largest healthcare fraud scheme ever charged by federal authorities resulting in a record $1.3 billion in claims.

An inpatient rehab company that paid $48 million to resolve allegations it submitted false patient diagnoses and admitted patients unnecessarily to bolster Medicare patients.

Three pharmaceutical companies agreed to pay more than $120 million to settle allegation of using nonprofit foundations to increase their proceeds from Medicare.

The government has made it clear that targeting healthcare fraud is a top priority. For more than 25 years, The Health Law Offices of Anthony C. Vitale has been representing clients under investigation by local, state and federal agencies. For more information you can contact us at 305-358-4500 or send us an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.