The Department of Justice (DOJ) published fiscal year 2021 False Claims Act data. The False Claims Act (31 U.S.C. §§3729-3733) (“FCA”) imposes liability on persons and companies who defraud the government. It is the federal government’s primary tool in combating fraud against the Government. https://wirskyelawfirm.com/false-claims-act-basics/. The DOJ recovered more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government This is the second largest annual total in FCA history, and the largest since 2014.
Notably, of the more than $5.6 billion recovered, over $5 billion involved the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. Areas of focus included opioid related cases, cases involving the Medicare Advantage Program (Medicare Part C), kickbacks and unnecessary medical services. Thus, healthcare providers should be particularly vigilant. Other areas of DOJ focus included COVID-related fraud (including payments under the PPP program), procurement fraud, cybersecurity and others. https://www.justice.gov/opa/pr/justice-department-s-false-claims-act-settlements-and-judgments-exceed-56-billion-fiscal-year; https://www.justice.gov/opa/press-release/file/1467811/download.
The DOJ also emphasized its commitment to hold individuals accountable under the FCA. This is consistent with the Biden administration’s strategy on fighting white collar crime. See https://wirskyelawfirm.com/doj-announces-new-white-collar-criminal-enforcement-policies.
Somewhat surprisingly, of the $5.6 billion recovered in fiscal year 2021, only $1.6 billion came from qui tam suits by relators or whistleblowers. However, this is consistent with the DOJ’s increasing use of computerized data to identify cases and pursue healthcare providers, as opposed to whistleblowers bringing cases.
Based upon FCA activity this year, DOJ policies and recent announcements, 2022 is expected to be another record-breaking year for FCA cases. The focus on healthcare fraud also shows no signs of slowing down.