Health-Care Fraud Enforcement: 2017 Year in Review & Trends and Predictions for 2018

After the election of Donald Trump to the U.S. presidency, many predicted 2017 would be a tumultuous year for the health-care industry, and indeed it was. With the parade of attempts to repeal portions of the Affordable Care Act, 2017 was filled with uncertainty not only for providers and payers but also for consumers who have relied on the exchanges for obtaining health-care coverage. Despite this uncertainty, one agenda that continues to remain nonpartisan and has withstood the Obama-Trump transition is the government's focus on ferreting out health-care fraud. This government focus, along with the increasing willingness of the relators’ bar to pursue False Claims Act (“FCA”) cases when the government declines to intervene, has placed (and will continue to place well into the future) every individual and entity participating in the health-care sector in the crosshairs of those who proclaim to combat health-care fraud.

In fact, health-care fraud recoveries continued to reach staggering numbers in 2017. For fiscal year (“FY”) 2017, the Department of Justice (“DOJ”) obtained more than $3.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government, $2.4 billion of which involved the health-care industry, including drug companies, hospitals, pharmacies, laboratories, and physicians. DOJ further reported 545 new matters relating to health-care fraud (492 of which were qui tam cases). While each of these matters is unique, actions and settlements by DOJ over the last 12 months do demonstrate some trends in health-care fraud enforcement (in both the civil and criminal context) that we would expect to continue into the second year of the Trump presidency.