The Justice Department obtained more than $5.6 billion in fraud and false claims settlements and judgments in the fiscal year ending Sept. 30, 2021, and most of the recoveries were related to healthcare.
The $5.6 billion represents the second-largest annual total recorded in False Claims Act history, and the largest since 2014, the Justice Department said in a Feb. 1 news release.
Five things to know about the recoveries:
1. The money was recovered from drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. The amount reflects recoveries solely from federal losses. In many cases, more money was recovered for state Medicaid programs.
2. The leading source of the settlements and judgments in fiscal year 2021 was healthcare fraud, and the largest False Claims Act settlements last fiscal year came from prescription opioid manufacturers. Drug company Indivior, for example, was ordered to pay $289 million in criminal penalties for marketing the opioid addiction treatment drug Suboxone.
3. The Justice Department investigated and litigated a growing number of Medicare Advantage program cases in fiscal year 2021. Sacramento, Calif.-based Sutter Health and several of its affiliates agreed to pay $90 million to resolve false claims allegations of submitting inaccurate information about Medicare Advantage beneficiaries.
4. The Justice Department resolved several cases involving kickback allegations in healthcare. One example cited by the Justice Department is that mail-order diabetic testing supply company Arriva Medical and its parent, Alere, agreeing to pay $160 million to settle allegations that Arriva paid kickbacks to Medicare beneficiaries.
5. The Justice Department also resolved cases in which providers billed federal healthcare programs for medically unnecessary services or services not rendered as billed. Alere, a medical device company acquired by Abbott in 2017, for instance, agreed to pay $38.75 million to resolve allegations that it knowingly billed Medicare for defective testing devices.