False Claims Act recoveries drop nearly 40 percent in 2015

Following a record-setting 2014, civil False Claims Act (FCA) recoveries saw a 39 percent decline in 2015, dropping to $3.5 billion overall, according to figures released by the Department of Justice (DOJ).

Federal FCA settlements and judgements from the healthcare industry also dropped slightly from $2.3 billion in 2014 to $1.9 billion in 2015, but the industry still accounted for more than half of all federal FCA recoveries.

Two major cases involving DaVita Healthcare Partners accounted for nearly half of those recoveries. In October 2014, the nation's second-largest dialysis provider agreed to pay $389 million to settle allegations that it paid physicians in exchange for patient referrals.  Months later, DaVita agreed to a $450 million FCA settlement for intentionally wasting larger vials of medicine and billing Medicare for the cost. Although the DOJ declined to intervene in that case, two whistleblowers ultimately won the case after prosecutors alleged that a DaVita witness had provided false testimony and defense attorneys had improperly coached witnesses.

In fact, 2015 was the best year on record for similar whistleblower cases in which the government declined to intervene, according to A. Brian Albritton, an attorney with Phelps Dunbar LLP, as those cases accounted for more than $1.1 billion in recoveries. However, Albritton pointed out that the 737 FCA cases and investigations filed in 2015 represented the lowest total since 2010.

Once again, whistleblowers were a major force in FCA recoveries, accounting for $2.8 billion on 638 lawsuits overall. For example, two whistleblowers initiated a $250 million FCA settlement with 450 hospitals across the country, $216 million of which was recovered during the 2015 fiscal year, according to the DOJ. Kickback settlements involving Adventist Health System, Broward Hospital District and Columbus Regional Healthcare System accounted for more than $200 million.

Pharmaceutical settlements also contributed to the FCA pot, including a $39 million settlement from Daiicki Sankyo and a $54 million joint settlement with AstraZeneca and Cephalon.

For more:
- here's the DOJ announcement
- read the Phelps Dunbar LLP post

Related Articles:
False Claims Act enforcement continues in high gear
Health systems cough up stiff settlements for overpaying docs
Federal False Claims Act scrutiny shows no signs of letting up
Daiichi Sankyo to pay $39M to settle DOJ claims it paid kickbacks to docs
National dialysis provider agrees to pay $450 million settlement for improper billing
DOJ settles with 450 hospitals for $250M over False Claims Act allegations

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.