The Department of Justice (DOJ) has announced more than $3 billion in False Claims Act (FCA) recoveries in FY 2011, including $2.4 billion in recoveries involving federal health care program fraud. The pharmaceutical industry was the source of the largest recoveries -- the DOJ reports almost $2.2 billion in civil claims against the pharmaceutical industry in FY 2011.
This post was written by Scot T. Hasselman.
In response to a letter dated December 17, 2010, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have outlined statistics associated with health care fraud prosecutions. In the letter, dated January 24, 2011, DOJ and HHS detail criminal and civil prosecutions for health care fraud. Among the highlights:
HHS and the Department of Justice (DOJ) have released the Health Care Fraud and Abuse Control Program Report for Fiscal Year 2010. According to the report, the federal government won or negotiated approximately $2.5 billion in health care fraud judgments and settlements during the period. Federal prosecutors had 1,787 health care fraud criminal investigations pending, involving 2,977 potential defendants. DOJ filed criminal charges in 488 cases involving 931 defendants and 726 defendants were convicted for health care fraud-related crimes during the period. In addition, DOJ opened 942 new civil health care fraud investigations in FY 2010 and had 1,290 matters pending at the end of the fiscal year. The HHS Office of Inspector General also excluded 3,340 individuals and entities, almost half of which resulted from licensure revocations.
The U.S. Department of Justice (DOJ) recovered $3 billion in False Claims Act civil settlements and judgments in fiscal year (FY) 2010 – a record $2.5 billion of which involved health care fraud recoveries -- the DOJ announced November 22, 2010. Most of the FY 2010 settlements and judgments (over $2.3 billion) were recovered in qui tam (whistleblower) lawsuits, resulting in $385 million in awards to relators. The largest FY 2010 False Claims Act recoveries involved the pharmaceutical and medical device industries, which accounted for $1.6 billion in settlements.
President Obama has signed into law H.R. 2923, the Combat Methamphetamine Enhancement Act. The new law requires retail sellers of products containing pseudoephedrine, ephedrine, and phenylpropanolamine that are precursors for methamphetamine to submit to the Department of Justice a self-certification that includes a statement that the seller understands and agrees to comply with the legal requirements with respect to these products.
Recent guidance and summary documents regarding Affordable Care Act implementation include the following:
The OIG and DOJ have released the “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2009.” In terms of overall health fraud enforcement efforts, the federal government won or negotiated approximately $1.63 billion in judgments and settlements during FY 2009. Also in FY 2009, U.S. Attorneys’ Offices opened 1,014 new criminal health care fraud investigations involving 1,786 potential defendants. Federal prosecutors had 1,621 health care fraud criminal investigations pending, involving 2,706 potential defendants, and filed criminal charges in 481 cases involving 803 defendants. A total of 583 defendants were convicted for health care fraud-related crimes during the year. Also in FY 2009, the DOJ opened 886 new civil health care fraud investigations and had 1,155 civil health care fraud matters pending. The report also includes a compilation of significant health fraud cases. In a related development, HHS and DOJ issued a press release highlighting provisions in the new health reform law that will build on current anti-fraud initiatives.
Deputy Attorney General Gary G. Grindler addressed the National Institute on Health Care Fraud on May 13, 2010 to discuss Obama Administration efforts to combat health fraud. In addition to discussing health reform legislation and the Health Care Fraud Prevention and Enforcement Action Team, he highlighted other ways DOJ “is seeking to combat crimes relating to the healthcare and pharmaceutical industries.” For instance, according to Mr. Grindler, the DOJ expects to increase the use of the Foreign Corrupt Practices Act (FCPA) to prosecute kickbacks and bribes paid to foreign government officials by pharmaceutical companies, given that “in some foreign countries, nearly every aspect of the approval, manufacture, import, export, pricing, sale and marketing of a drug product may involve a “foreign official” within the meaning of the FCPA.” He warned that DOJ “will not hesitate to charge pharmaceutical companies and their senior executives under the FCPA if warranted to root out foreign bribery in the industry.” The DOJ also will continue to focus on intellectual property theft involving the pharmaceutical industry, including efforts to combat the sale of counterfeit and dangerous drugs.
On January 28, 2010, Reed Smith Partner Elizabeth Carder-Thompson, in her capacity as president of the American Health Lawyers Association, attended the National Summit on Health Care Fraud, sponsored by the U.S. Department of Health and Human Services and the U.S. Department of Justice. Ms. Carder-Thompson’s observations on the summit are available on our sister blog, Life Sciences Legal Update.
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